Provider Demographics
NPI:1982805453
Name:MARCHESE, COLLEEN R (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:R
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ECHELON RD
Mailing Address - Street 2:APT. 9
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 EVES DR
Practice Address - Street 2:SUITE 160
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3135
Practice Address - Country:US
Practice Address - Phone:856-985-9257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00513300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist