Provider Demographics
NPI:1578296497
Name:COLLINS, STEPHANIE LEANN (BC-HIS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LEANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BONHAM RD STE 5
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5980
Mailing Address - Country:US
Mailing Address - Phone:276-466-4327
Mailing Address - Fax:276-466-4343
Practice Address - Street 1:102 BONHAM RD STE 5
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5980
Practice Address - Country:US
Practice Address - Phone:276-466-4327
Practice Address - Fax:276-466-4343
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2102003121237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2102003121OtherLICENSE NUMBER