Provider Demographics
NPI:1861972762
Name:KRIZAK, COLLEEN ANN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:KRIZAK
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 1:4033 MOORHEAD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5522
Mailing Address - Country:US
Mailing Address - Phone:210-792-6332
Mailing Address - Fax:
Practice Address - Street 1:1301 S TERRELL ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-4902
Practice Address - Country:US
Practice Address - Phone:361-325-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist