Provider Demographics
NPI:1699085167
Name:COLLETTI, MARY E (MS ED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:COLLETTI
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-5125
Mailing Address - Country:US
Mailing Address - Phone:845-985-7493
Mailing Address - Fax:
Practice Address - Street 1:23 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2149
Practice Address - Country:US
Practice Address - Phone:845-794-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist