Provider Demographics
NPI:1831750538
Name:KOLONICK, ALISON L
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:L
Last Name:KOLONICK
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 1:150 N MILLER RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3713
Mailing Address - Country:US
Mailing Address - Phone:303-867-2240
Mailing Address - Fax:303-630-3198
Practice Address - Street 1:3505 E ROYALTON RD STE 221
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2998
Practice Address - Country:US
Practice Address - Phone:440-241-8366
Practice Address - Fax:440-736-7600
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND20191080-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOND.20191080-SPOtherOHIO SPEECH AND HEARING PROFESSIONALS BOARD