Individual
COLETTE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
4428 4TH AVE N, GREAT FALLS, MT 59405-1401
(312) 639-3072
Mailing address
4428 4TH AVE N, GREAT FALLS, MT 59405-1401
(312) 639-3072
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-SP-LIC-12202
MT
235Z00000X
Speech-Language Pathologist
SLP7600
NM
235Z00000X
Speech-Language Pathologist
SP-2868
NV
Other
Enumeration date
09/22/2020
Last updated
05/06/2024
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