Provider Demographics
NPI:1629837356
Name:COLLINS, AUTUMN
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:
Last Name:COLLINS
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 1:1021 EDEN WAY N STE 110
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2776
Mailing Address - Country:US
Mailing Address - Phone:757-547-3560
Mailing Address - Fax:757-547-5053
Practice Address - Street 1:1021 EDEN WAY N STE 110
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2776
Practice Address - Country:US
Practice Address - Phone:757-547-3560
Practice Address - Fax:757-547-5053
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002800237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist