Provider Demographics
NPI:1942825856
Name:COLLINS, BREANNA (AUD)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19110 MONTGOMERY VILLAGE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3706
Mailing Address - Country:US
Mailing Address - Phone:301-977-6317
Mailing Address - Fax:301-977-8503
Practice Address - Street 1:621 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2572
Practice Address - Country:US
Practice Address - Phone:704-799-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD799155000Medicaid