Individual
MRS. COLLEEN ROBBINS POUQUETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
812 VALLEY ST, PRESCOTT, AZ 86305-1826
(928) 445-1309
(928) 445-0914
Mailing address
PO BOX 11312, PRESCOTT, AZ 86304-1312
(928) 445-1309
(928) 445-0914
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
AZSLP0044
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00804385
ASHA MEMBERSHIP
—
Enumeration date
06/03/2006
Last updated
10/03/2013
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