MEDICARE: MRS. COLLEEN E NELSON M.A., 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	9884	NC

General Provider Information

NPI Number	:	1942622295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN E NELSON M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	606 BELLEMEADE ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1903
Country	:	US
Telephone Number	:	248-535-6084
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-713-8330
Fax Number	:

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

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/06/2014

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Directions to “ MRS. COLLEEN E NELSON M.A., CCC-SLP” Practice Location

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