Provider Demographics
NPI:1578041489
Name:COLLIN, JODI ANN
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:ANN
Last Name:COLLIN
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 1:33 HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4433
Mailing Address - Country:US
Mailing Address - Phone:860-817-4132
Mailing Address - Fax:
Practice Address - Street 1:33 HARRIS DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4433
Practice Address - Country:US
Practice Address - Phone:860-817-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker