Provider Demographics
NPI:1396025771
Name:COLLINS, SUZANNE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:COLLINS
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 1:7139 WESTBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1831
Mailing Address - Country:US
Mailing Address - Phone:214-987-1600
Mailing Address - Fax:214-242-3922
Practice Address - Street 1:7139 WESTBROOK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-1831
Practice Address - Country:US
Practice Address - Phone:214-987-1600
Practice Address - Fax:214-242-3922
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty