Provider Demographics
NPI:1639302581
Name:COLLINS, CAROL DIANE (MA, CCP/SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DIANE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA, CCP/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12941 NORTH FREEWAY, SUITE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1956
Mailing Address - Country:US
Mailing Address - Phone:832-253-1188
Mailing Address - Fax:832-253-1181
Practice Address - Street 1:12941 NORTH FREEWAY
Practice Address - Street 2:SUITE 401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1956
Practice Address - Country:US
Practice Address - Phone:832-253-1188
Practice Address - Fax:713-696-2133
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist