Provider Demographics
NPI:1336369776
Name:POWELL, COLETTE SUZANNE (MNS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:SUZANNE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MNS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 E CULVER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1205
Mailing Address - Country:US
Mailing Address - Phone:480-982-1110
Mailing Address - Fax:480-474-8370
Practice Address - Street 1:550 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-5002
Practice Address - Country:US
Practice Address - Phone:480-982-1110
Practice Address - Fax:480-474-8370
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist