Provider Demographics
NPI:1053086371
Name:COLLINSWORTH, CRICKET (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRICKET
Middle Name:
Last Name:COLLINSWORTH
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 1:2514 DOWNS ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5116
Mailing Address - Country:US
Mailing Address - Phone:318-366-3558
Mailing Address - Fax:
Practice Address - Street 1:2206 BECKETT ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3730
Practice Address - Country:US
Practice Address - Phone:318-366-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty