Provider Demographics
NPI:1134174857
Name:LAMBERT, COLLEEN ANN
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 WEHLER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-7184
Mailing Address - Country:US
Mailing Address - Phone:704-293-1972
Mailing Address - Fax:866-440-5265
Practice Address - Street 1:264 WEHLER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-7184
Practice Address - Country:US
Practice Address - Phone:704-293-1972
Practice Address - Fax:866-440-5265
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412388Medicaid