Provider Demographics
NPI:1134651672
Name:COLLINGS, NICOLE (M A, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:COLLINGS
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 LANCASTER DR NE # 369
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2933
Mailing Address - Country:US
Mailing Address - Phone:971-374-2550
Mailing Address - Fax:971-374-2551
Practice Address - Street 1:744 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2506
Practice Address - Country:US
Practice Address - Phone:971-374-2550
Practice Address - Fax:971-374-2551
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist