Provider Demographics
NPI:1033284336
Name:COLLINS, JEN T (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JEN
Middle Name:T
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 MONTGOMERY BLVD NE APT 334
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1009
Mailing Address - Country:US
Mailing Address - Phone:505-440-7177
Mailing Address - Fax:
Practice Address - Street 1:3829 MONTGOMERY BLVD NE APT 334
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1009
Practice Address - Country:US
Practice Address - Phone:505-440-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist