Provider Demographics
NPI:1730578790
Name:COLLAZO, LOUISE MICHELLE
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:MICHELLE
Last Name:COLLAZO
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:A-4 CALLE 1
Mailing Address - Street 2:UBR. FRANCISCO OLLER
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4416
Mailing Address - Country:US
Mailing Address - Phone:787-367-8646
Mailing Address - Fax:
Practice Address - Street 1:130 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3012
Practice Address - Country:US
Practice Address - Phone:787-869-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist