Provider Demographics
NPI:1194372672
Name:COLSTON, BRITTANY NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:NICOLE
Last Name:COLSTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:NICOLE
Other - Last Name:RUETSCHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2046 BETH ANN WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4770
Mailing Address - Country:US
Mailing Address - Phone:937-266-3336
Mailing Address - Fax:
Practice Address - Street 1:110 COMSTOCK ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1006
Practice Address - Country:US
Practice Address - Phone:937-855-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist