Provider Demographics
NPI:1962554246
Name:COLANDO, PATRICIA JACKSON (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JACKSON
Last Name:COLANDO
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:JACKSON COLANDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18721 PORTOFINO DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3404
Mailing Address - Country:US
Mailing Address - Phone:949-854-0605
Mailing Address - Fax:949-854-3606
Practice Address - Street 1:23072 LAKE CENTER DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2800
Practice Address - Country:US
Practice Address - Phone:949-854-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist