Provider Demographics
NPI:1710363882
Name:ANDERSEN, COLLIN JOSEPH (HAD-T)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:JOSEPH
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:HAD-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E SUNSET RD
Mailing Address - Street 2:UNIT 5-260
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3511
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:780 W OLIVE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2437
Practice Address - Country:US
Practice Address - Phone:209-722-3325
Practice Address - Fax:209-383-0802
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHTL-9272237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist