Provider Demographics
NPI:1447313689
Name:GRULLON-COLON, AILEEN MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:MARIE
Last Name:GRULLON-COLON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 W SUNRISE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-536-1806
Mailing Address - Fax:954-514-1126
Practice Address - Street 1:14201 W SUNRISE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-756-2818
Practice Address - Fax:954-514-1126
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888570200Medicaid
FL888570200Medicaid