Provider Demographics
NPI:1083849376
Name:KOLLIE, JANDA R
Entity Type:Individual
Prefix:
First Name:JANDA
Middle Name:R
Last Name:KOLLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3347 QUEENSWOOD BLVD
Mailing Address - Street 2:BLVD
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1166
Mailing Address - Country:US
Mailing Address - Phone:419-787-6363
Mailing Address - Fax:
Practice Address - Street 1:3347 QUEENSWOOD BLVD
Practice Address - Street 2:BLVD
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1166
Practice Address - Country:US
Practice Address - Phone:419-787-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor