Healthcare Provider Details

I. General information

NPI: 1528346582
Provider Name (Legal Business Name): COLLEEN CASSELTON PERRY M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN O'TOOLE CASSELTON M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W WILLIAMS ST STE 202
APEX NC
27502-5203
US

IV. Provider business mailing address

100 WELLSPRING DR
HOLLY SPRINGS NC
27540-9322
US

V. Phone/Fax

Practice location:
  • Phone: 919-610-9298
  • Fax:
Mailing address:
  • Phone: 804-475-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12627
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: