MEDICARE: MS. COLLEEN ANN HANEY MED 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	SA6319	FL

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	:	1831174788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN ANN HANEY MED CCC SLP

Provider Business Mailing Address
First Line	:	800 E CAMINO REAL
Second Line	:	#411
City	:	BOCA RATON
State	:	FL
Zip	:	33432
Country	:	US
Telephone Number	:	561-417-4903
Fax Number	:	561-417-8986

Provider Business Practice Location Address
First Line	:	3066 JOG RD
Second Line	:	ADVANCED PEDIATRIC SYSTEMS
City	:	GREENACRES
State	:	FL
Zip	:	33467
Country	:	US
Telephone Number	:	561-357-5883
Fax Number	:	561-357-5884

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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