Provider Demographics
NPI:1245657691
Name:COLIVAS, CAITLIN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:COLIVAS
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 1:810 LAWRENCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2208
Mailing Address - Country:US
Mailing Address - Phone:805-273-3870
Mailing Address - Fax:805-273-3871
Practice Address - Street 1:810 LAWRENCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2208
Practice Address - Country:US
Practice Address - Phone:805-273-3870
Practice Address - Fax:805-273-3871
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 21665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist