Provider Demographics
NPI:1831174788
Name:HANEY, COLLEEN ANN (MED CCC SLP)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:HANEY
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CAMINO REAL
Mailing Address - Street 2:#411
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-417-4903
Mailing Address - Fax:561-417-8986
Practice Address - Street 1:3066 JOG RD
Practice Address - Street 2:ADVANCED PEDIATRIC SYSTEMS
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-357-5883
Practice Address - Fax:561-357-5884
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist