Provider Demographics
NPI:1942619622
Name:COLLINS, JEAN LOUISE (PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JEAN LOUISE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424F CATASAUQUA RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7473
Mailing Address - Country:US
Mailing Address - Phone:610-317-6064
Mailing Address - Fax:
Practice Address - Street 1:1424F CATASAUQUA RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7473
Practice Address - Country:US
Practice Address - Phone:610-317-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK00839171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist