Provider Demographics
NPI:1447371380
Name:WOODS-FRERICHS, COLLEEN P (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:P
Last Name:WOODS-FRERICHS
Suffix:
Gender:F
Credentials:MS 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:S82W24150 ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9609
Mailing Address - Country:US
Mailing Address - Phone:309-274-4696
Mailing Address - Fax:
Practice Address - Street 1:S82W24150 ARTESIAN AVE
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9609
Practice Address - Country:US
Practice Address - Phone:309-274-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006240235Z00000X
WI4146-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist