Provider Demographics
NPI:1043732613
Name:ZENCZAK-MAGILL, COLLEEN KELLEHER (AUD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:KELLEHER
Last Name:ZENCZAK-MAGILL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:KELLEHER
Other - Last Name:ZENCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:601 N CAROLINE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0006
Mailing Address - Country:US
Mailing Address - Phone:410-955-6153
Mailing Address - Fax:443-287-6340
Practice Address - Street 1:601 N CAROLINE ST FL 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-955-6153
Practice Address - Fax:443-287-6340
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01410231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist