Individual
LARA KATHRYN COLLICOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPEECH PATHOLOGIST
Contact information
Practice address
163 VAN BUREN RD, CARIBOU, ME 04736-3567
(207) 498-3111
(207) 498-1653
Mailing address
163 VAN BUREN RD, CARIBOU, ME 04736-3567
(207) 498-3111
(207) 498-1653
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
759
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268080099
—
ME
Enumeration date
05/08/2007
Last updated
12/30/2009
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