Provider Demographics
NPI:1578849014
Name:COLLINS, CAROLE JENNIFER (L-SLP/CCC)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:JENNIFER
Last Name:COLLINS
Suffix:
Gender:F
Credentials:L-SLP/CCC
Other - Prefix:MS
Other - First Name:CAROLE
Other - Middle Name:JENNIFER
Other - Last Name:DENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:L-SLP/CCC
Mailing Address - Street 1:8061 E BENNETT HTS
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1070
Mailing Address - Country:US
Mailing Address - Phone:585-345-0240
Mailing Address - Fax:
Practice Address - Street 1:8061 E BENNETT HTS
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1070
Practice Address - Country:US
Practice Address - Phone:585-345-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008136-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist