Provider Demographics
NPI:1790935633
Name:COLLINS, CARRIE (MS SLP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:KATHLEEN
Other - Last Name:COLLINS-BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP
Mailing Address - Street 1:SIH PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902
Mailing Address - Country:US
Mailing Address - Phone:618-942-2171
Mailing Address - Fax:
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO242.000738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL005830Medicaid