Provider Demographics
NPI:1578855102
Name:COLLINS, CHRISTA SHEREE (MS CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:SHEREE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:MISS
Other - First Name:CHRISTA
Other - Middle Name:SHEREE
Other - Last Name:CROTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-0015
Mailing Address - Country:US
Mailing Address - Phone:405-397-3550
Mailing Address - Fax:405-399-2350
Practice Address - Street 1:1620 MIDTOWN PLACE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6217
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:405-399-2350
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200438530AMedicaid