Provider Demographics
NPI:1417557802
Name:COLLINS, AMANDA (MS, CCC-SLP; CBIS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, CCC-SLP; CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 VILLA CREEK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7385
Mailing Address - Country:US
Mailing Address - Phone:972-241-9334
Mailing Address - Fax:
Practice Address - Street 1:2655 VILLA CREEK DR STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7385
Practice Address - Country:US
Practice Address - Phone:972-241-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist