Provider Demographics
NPI:1508005083
Name:COLLINS, JODI LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3418
Mailing Address - Country:US
Mailing Address - Phone:302-299-8239
Mailing Address - Fax:
Practice Address - Street 1:202 N BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3418
Practice Address - Country:US
Practice Address - Phone:302-299-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0002666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist