MEDICARE: KRISTEN MARIE COLLATOS

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	SP01279	RI

General Provider Information

NPI Number	:	1427455161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE COLLATOS

Provider Business Mailing Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2770
Country	:	US
Telephone Number	:	401-737-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2770
Country	:	US
Telephone Number	:	401-737-7010
Fax Number	:

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

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	07/07/2021

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Directions to “ KRISTEN MARIE COLLATOS ” Practice Location

Language	Start Address	Practice Location

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