Colette Dominguez, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-SP-LIC-12202 Issued in MT

Practice address

4428 4TH Ave N
Great Falls, MT 59405-1401

Phone

(312) 639-3072

NPI assigned

Sep 22, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Colette Fortin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Speechbliss Therapy, LLC

  • Speech-Language Pathologist
  • Great Falls, MT
  • NPI 1053168104
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1376159558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4428 4TH AVE N",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594051401",
            "telephone_number": "312-639-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4428 4TH AVE N",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594051401",
            "telephone_number": "312-639-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "COLETTE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NV",
            "license": "SP-2868",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "SLP7600",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MT",
            "license": "SLP-SP-LIC-12202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLETTE",
            "last_name": "FORTIN",
            "credential": "MA CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Darrin Lee Dixon, CRNA
• Aspen Dodge
• Paul Gregory Dolan, M.D.
• Chelsie Dollar
• Hannah R. Dolson
• Philip E Donahue, FNP
• Donald H Berdeaux MD Facp PC
• Jill Elizabeth Donaldson, APRN
• Matthew Dooper, OD
• Michael F Doubek, MD

• Speech-Language Pathologist in Great Falls, MT
• Providers in Great Falls, MT by specialty
• Speech-Language Pathologist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.