Provider Demographics
NPI:1720262876
Name:LAVELLE, COLLEEN ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-0785
Mailing Address - Country:US
Mailing Address - Phone:970-668-0888
Mailing Address - Fax:970-668-0227
Practice Address - Street 1:360 ONE PEAK DRIVE
Practice Address - Street 2:SUITE 190
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-0785
Practice Address - Country:US
Practice Address - Phone:970-668-0888
Practice Address - Fax:970-668-0227
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01077531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist