Provider Demographics
NPI:1134747934
Name:COLLETT, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:COLLETT
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 1:501 E OLTORF ST APT 227
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5625
Mailing Address - Country:US
Mailing Address - Phone:630-390-5150
Mailing Address - Fax:
Practice Address - Street 1:1340 WONDER WORLD DR STE 4301
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7695
Practice Address - Country:US
Practice Address - Phone:855-547-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81124231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist