Provider Demographics
NPI:1770749053
Name:ENGER, COLLEEN MARIE
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:ENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 57TH ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1441
Mailing Address - Country:US
Mailing Address - Phone:708-567-4189
Mailing Address - Fax:
Practice Address - Street 1:612 57TH ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1441
Practice Address - Country:US
Practice Address - Phone:708-567-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000927235Z00000X
IL146009833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist