MEDICARE: COLLEEN LYNN MCSHEA MS, CCC-SLP

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	SLP4317	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	:	1386701431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN LYNN MCSHEA MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5601 HIGHWAY 95 N STE 308C
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-8546
Country	:	US
Telephone Number	:	928-854-5439
Fax Number	:	928-854-5440

Provider Business Practice Location Address
First Line	:	5601 HIGHWAY 95 N STE 308C
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-8546
Country	:	US
Telephone Number	:	928-854-5439
Fax Number	:	928-854-5440

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

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	10/18/2024

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