Healthcare Provider Details

I. General information

NPI: 1427455161
Provider Name (Legal Business Name): KRISTEN MARIE COLLATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MARIE TROY MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7010
  • Fax:
Mailing address:
  • Phone: 401-737-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP01279
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: