Provider Demographics
NPI:1992245799
Name:COLLAZO-TORRES, JOAN IVETTE
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:IVETTE
Last Name:COLLAZO-TORRES
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 1:285 UPTOWN BLVD APT 540
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4005
Mailing Address - Country:US
Mailing Address - Phone:787-409-9453
Mailing Address - Fax:
Practice Address - Street 1:285 UPTOWN BLVD APT 540
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4005
Practice Address - Country:US
Practice Address - Phone:787-409-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117416235Z00000X
NY027726235Z00000X
235Z00000X
FLSA21331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1992245799Medicaid