Provider Demographics
NPI:1528308509
Name:COLON, LAURIE
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-6203
Mailing Address - Country:US
Mailing Address - Phone:407-317-7430
Mailing Address - Fax:
Practice Address - Street 1:200 OAKWOOD LN STE 100
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1929
Practice Address - Country:US
Practice Address - Phone:954-561-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No252Y00000XAgenciesEarly Intervention Provider Agency