Provider Demographics
NPI:1316307879
Name:IMERMAN, COLLEEN (MA)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:IMERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WILD TURKEY LANE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127
Mailing Address - Country:US
Mailing Address - Phone:720-987-9795
Mailing Address - Fax:
Practice Address - Street 1:8 WILD TURKEY LANE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127
Practice Address - Country:US
Practice Address - Phone:720-987-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02-210-0694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist