Provider Demographics
NPI:1922797109
Name:FORD, COLLEEN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 FIRST PARISH RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-3834
Mailing Address - Country:US
Mailing Address - Phone:781-812-4271
Mailing Address - Fax:
Practice Address - Street 1:40 WILLARD ST STE 203
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1252
Practice Address - Country:US
Practice Address - Phone:617-463-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist