Healthcare Provider Details

I. General information

NPI: 1962867531
Provider Name (Legal Business Name): COLLEEN TUOHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHARLEVOIX DR SE SUITE 200
GRAND RAPIDS MI
49546-7085
US

IV. Provider business mailing address

2900 CHARLEVOIX DR SE SUITE 200
GRAND RAPIDS MI
49546-7085
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-5000
  • Fax:
Mailing address:
  • Phone: 616-975-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 23646
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0002341
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: