Provider Demographics
NPI:1356563282
Name:ENDRIZZI, COLLEEN MARY MARTENS (PHD (IS)MS, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARY MARTENS
Last Name:ENDRIZZI
Suffix:
Gender:F
Credentials:PHD (IS)MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:MARTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LLCC, CCC-SLP
Mailing Address - Street 1:11565 E GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-5634
Mailing Address - Country:US
Mailing Address - Phone:612-554-5005
Mailing Address - Fax:
Practice Address - Street 1:130 HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4571
Practice Address - Country:US
Practice Address - Phone:352-419-6570
Practice Address - Fax:888-639-2521
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15428OtherLICENSE