MEDICARE: COLLEEN MARIE NOLAN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	9913	NC
2	235Z00000X	Speech-Language Pathologist	15227	CA
3	235Z00000X	Speech-Language Pathologist	6995	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12407831	OTHER	NC	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265599955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MARIE NOLAN CCC-SLP

Provider Business Mailing Address
First Line	:	521 KING EDWARD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4627
Country	:	US
Telephone Number	:	858-354-0453
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 KING EDWARD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4627
Country	:	US
Telephone Number	:	858-354-0453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	12/10/2025

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Directions to “ COLLEEN MARIE NOLAN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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