Individual
COLLEEN ROSE WITT BONNICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
6121 COBURG LN, MISSOULA, MT 59803-9501
(499) 933-4152
Mailing address
7200 S ALTON WAY # 250, CENTENNIAL, CO 80112-2201
(720) 488-9040
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
0001571
CO
235Z00000X
Speech-Language Pathologist
Primary
2019031366
MO
235Z00000X
Speech-Language Pathologist
8963
MA
Other
Enumeration date
10/29/2013
Last updated
02/19/2020
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