MEDICARE: COLLIGO SPEECH LANGUAGE PATHOLOGY, PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164097184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIGO SPEECH LANGUAGE PATHOLOGY, PA

Provider Business Mailing Address
First Line	:	8830 S LAKE DASHA DR
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3011
Country	:	US
Telephone Number	:	305-283-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 S LAKE DASHA DR
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3011
Country	:	US
Telephone Number	:	305-283-4800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KRIS-ANN CHIN-AMBROSE
Credential	:
Telephone Number	:	305-283-4800

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	01/21/2022

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Directions to “COLLIGO SPEECH LANGUAGE PATHOLOGY, PA ” Practice Location

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