Lara Kathryn Collicott, SPEECH PATHOLOGIST
Individual provider Active NPI Speech-Language Pathologist · Caribou, ME
NPI 1063625713 · NPPES record last updated Dec 30, 2009
Key facts
- NPI
- 1063625713
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 759 (ME)
- Practice address
- 163 Van Buren Rd
Caribou, ME 04736-3567 - Phone
- (207) 498-3111
- Fax
- (207) 498-1653
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201122000031 | ME | Practitioner - Qualified Speech Language Pathologist | 8527479641 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 759 | ME | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Caribou | Current |
Accepting new patients | |
| Aroostook Mental Health Services, Inc. | Past | Accepting new patients |
Locations
163 Van Buren Rd
Caribou, ME 04736
Phone (207) 498-1320
163 Van Buren Rd
Ste 1
Caribou, ME 04736
Phone (207) 498-1227
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 759 | ME | Yes |
Addresses
Primary practice location
163 Van Buren Rd
Caribou, ME 04736-3567
Mailing address
163 Van Buren Rd
Caribou, ME 04736-3567
Phone (207) 498-3111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 268080099 | Medicaid | ME |
Other providers in Caribou, ME
- City of Caribou
- City of Caribou
- Victoria Marilyn Clark
- Alexis Coiley
- Beth Ann Collamore
- David Lee Conner
- Sarah E Corbett
- Freeman R. Corey
- Angela Beth Cormier
- County Optical Inc
All providers in Caribou, ME · Speech-Language Pathologist in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.