NPI 1376159558 · live from the CMS NPI Registry
Colette Dominguez, MA CCC-SLP
Speech-Language Pathologist, in Great Falls, MT. National Provider Identifier 1376159558, active.
NPI record
| NPI | 1376159558 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Speech-Language Pathologist, 235Z00000X |
| Practice location | 4428 4th Ave N, Great Falls, MT 59405 |
| Practice phone | 312-639-3072 |
| Enumerated | September 22, 2020 |
| Last updated | May 6, 2024 |
| Sole proprietor | No |
| Other names | Colette Fortin |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Speech-Language Pathologist, | 235Z00000X | sp-2868 (NV) |
| Speech-Language Pathologist, | 235Z00000X | slp7600 (NM) |
| Speech-Language Pathologist, primary | 235Z00000X | slp-sp-lic-12202 (MT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.