Provider Demographics
NPI:1225476724
Name:COLLINS, LINDSAY KRYSTINA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KRYSTINA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W CENTRAL AVE APT 1202
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9063
Mailing Address - Country:US
Mailing Address - Phone:559-367-2865
Mailing Address - Fax:
Practice Address - Street 1:500 W CENTRAL AVE APT 1202
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9063
Practice Address - Country:US
Practice Address - Phone:559-367-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist