Colleen Bridget Wallace, M.S, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

489 Issued in AK

Practice address

4050 Lake Otis Pkwy
Suite 201
Anchorage, AK 99508-5223

Phone

(505) 489-7764

NPI assigned

Mar 2, 2015

Last updated

Apr 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Durable Medical Equipment of Alaska LLC

  • Durable Medical Equipment & Medical Supplies
  • Anchorage, AK
  • NPI 1912622929
  NPD

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1427440387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 ROMIG PL",
            "address_2": "# 406",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995031680",
            "telephone_number": "505-489-7764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 LAKE OTIS PKWY",
            "address_2": "SUITE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085223",
            "telephone_number": "505-489-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COLLEEN",
        "middle_name": "BRIDGET",
        "credential": "M.S, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-02",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AK",
            "license": "489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1031087",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trevor Rhys Walker
• Virginia Walker, ANP
• William Walker
• Linda Jean Wall, LMT
• Amye Wallace
• Matthew Wallace
• Natalie Hale Wallace, MD, MPH
• Rori Wallace, DPT
• Ryan Myles Wallace
• Sarah Beth Wallace

• Speech-Language Pathologist in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Speech-Language Pathologist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.