NPI 1174951164 · live from the CMS NPI Registry
Colleen Rose Witt Bonnicksen, M.S. CCC-SLP
Speech-Language Pathologist, in Missoula, MT. National Provider Identifier 1174951164, active.
NPI record
| NPI | 1174951164 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Speech-Language Pathologist, 235Z00000X |
| Practice location | 6121 Coburg Ln, Missoula, MT 59803 |
| Practice phone | 499-933-4152 |
| Mailing address | 7200 S Alton Way # 250, Centennial, CO 80112 |
| Enumerated | October 29, 2013 |
| Last updated | February 19, 2020 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Speech-Language Pathologist, | 235Z00000X | 0001571 (CO) |
| Speech-Language Pathologist, | 235Z00000X | 8963 (MA) |
| Speech-Language Pathologist, primary | 235Z00000X | 2019031366 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.