Provider Demographics
NPI:1104077627
Name:COLLINS, VERONICA LYNN
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 GRANT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3439
Mailing Address - Country:US
Mailing Address - Phone:219-887-5146
Mailing Address - Fax:219-884-2756
Practice Address - Street 1:2200 GRANT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3439
Practice Address - Country:US
Practice Address - Phone:219-887-5146
Practice Address - Fax:219-884-2756
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100142050AMedicaid