Provider Demographics
NPI:1982049870
Name:SCHILLER, COLLEEN MARIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARIE
Last Name:SCHILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:CLINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:7167 E PUEBLO AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1730
Mailing Address - Country:US
Mailing Address - Phone:928-710-6514
Mailing Address - Fax:
Practice Address - Street 1:10221 SLATER AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4748
Practice Address - Country:US
Practice Address - Phone:714-964-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist