Provider Demographics
NPI:1275410219
Name:COLLINS, CONNOR (HIS)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PACHA PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4865
Mailing Address - Country:US
Mailing Address - Phone:319-665-2331
Mailing Address - Fax:
Practice Address - Street 1:650 PACHA PKWY STE 7
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4865
Practice Address - Country:US
Practice Address - Phone:319-665-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123907237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist