MEDICARE: MIKAYLA COLT

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	2204001727	VA

General Provider Information

NPI Number	:	1518578681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA COLT

Provider Business Mailing Address
First Line	:	2612 BUFORD RD STE A
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-3422
Country	:	US
Telephone Number	:	804-806-3933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 BUFORD RD STE A
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-3422
Country	:	US
Telephone Number	:	804-806-3933
Fax Number	:

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

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	01/14/2026

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Directions to “ MIKAYLA COLT ” Practice Location

Language	Start Address	Practice Location

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