MEDICARE: MRS. COLLEEN ELIN

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	002139	IA

General Provider Information

NPI Number	:	1649725920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN ELIN

Provider Business Mailing Address
First Line	:	330 N STEWART ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9798
Country	:	US
Telephone Number	:	563-880-8457
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 N STEWART ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9798
Country	:	US
Telephone Number	:	563-880-8457
Fax Number	:

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

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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Directions to “ MRS. COLLEEN ELIN ” Practice Location

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