Provider Demographics
NPI:1083480669
Name:COLLINS, BRENNA (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14391 N DOVE LN
Mailing Address - Street 2:
Mailing Address - City:BLUFORD
Mailing Address - State:IL
Mailing Address - Zip Code:62814-4110
Mailing Address - Country:US
Mailing Address - Phone:618-472-1203
Mailing Address - Fax:
Practice Address - Street 1:14391 N DOVE LN
Practice Address - Street 2:
Practice Address - City:BLUFORD
Practice Address - State:IL
Practice Address - Zip Code:62814-4110
Practice Address - Country:US
Practice Address - Phone:618-472-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist