Provider Demographics
NPI:1609601368
Name:BADGERO, COLLEEN NICOLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:NICOLE
Last Name:BADGERO
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 1:17415 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3479
Mailing Address - Country:US
Mailing Address - Phone:734-673-5432
Mailing Address - Fax:
Practice Address - Street 1:17415 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3479
Practice Address - Country:US
Practice Address - Phone:734-673-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist