Provider Demographics
NPI:1104660372
Name:COLLICHIO, CAELA ANN (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CAELA
Middle Name:ANN
Last Name:COLLICHIO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W INA RD APT 4203
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2164
Mailing Address - Country:US
Mailing Address - Phone:704-677-0707
Mailing Address - Fax:
Practice Address - Street 1:3220 W INA RD APT 4203
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2164
Practice Address - Country:US
Practice Address - Phone:704-677-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP15229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist