Provider Demographics
NPI:1144815036
Name:COLGROVE, ELISA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:COLGROVE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 65TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6545
Mailing Address - Country:US
Mailing Address - Phone:205-534-0128
Mailing Address - Fax:
Practice Address - Street 1:432 65TH ST STE B
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-6545
Practice Address - Country:US
Practice Address - Phone:205-534-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist