Provider Demographics
NPI:1598899585
Name:COLLINS, MARILYN (SLP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4381
Mailing Address - Country:US
Mailing Address - Phone:870-581-2646
Mailing Address - Fax:
Practice Address - Street 1:7950 HWY 70 W.
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:AR
Practice Address - Zip Code:72372
Practice Address - Country:US
Practice Address - Phone:870-581-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist