Provider Demographics
NPI:1083824049
Name:COLLINS, CONSTANCE (SLP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:7223 MAUMEE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9755
Mailing Address - Country:US
Mailing Address - Phone:419-865-0251
Mailing Address - Fax:419-724-3353
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-474-3399
Practice Address - Fax:419-474-5165
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208864Medicaid
OH366706Medicare ID - Type Unspecified