Provider Demographics
NPI:1700041183
Name:COLLINS, JASON (CCC/SLP-L)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4606
Mailing Address - Country:US
Mailing Address - Phone:716-228-7571
Mailing Address - Fax:716-883-1482
Practice Address - Street 1:60 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4606
Practice Address - Country:US
Practice Address - Phone:716-228-7571
Practice Address - Fax:716-883-1482
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist