Provider Demographics
NPI:1659647485
Name:COLLINS, LISA DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DAWN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2489 COUNTY HOME ROAD APT 181
Mailing Address - Street 2:
Mailing Address - City:GREENVILE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-622-2689
Mailing Address - Fax:252-355-9218
Practice Address - Street 1:850 JOHNS HOPKINS DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27835
Practice Address - Country:US
Practice Address - Phone:252-916-1029
Practice Address - Fax:252-355-9218
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist