MEDICARE: MS. COLLEEN M WAYNE B.S.

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	#SLPL5214	AZ

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	:	1205964806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN M WAYNE B.S.

Provider Business Mailing Address
First Line	:	4215 N DRINKWATER BLVD APT 272
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3958
Country	:	US
Telephone Number	:	602-523-8715
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 N 13TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-3400
Country	:	US
Telephone Number	:	602-523-8715
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/09/2007

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Directions to “ MS. COLLEEN M WAYNE B.S.” Practice Location

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