Provider Demographics
NPI:1528346582
Name:PERRY, COLLEEN CASSELTON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CASSELTON
Last Name:PERRY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:O'TOOLE
Other - Last Name:CASSELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:100 WELLSPRING DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9322
Mailing Address - Country:US
Mailing Address - Phone:804-475-9087
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST STE 202
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-610-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12627235Z00000X
VA2202006314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist