Provider Demographics
NPI:1295899292
Name:COLLIER, DEIDRA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 STONEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6617
Mailing Address - Country:US
Mailing Address - Phone:678-557-9014
Mailing Address - Fax:678-393-9487
Practice Address - Street 1:8260 STONEBROOK CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6617
Practice Address - Country:US
Practice Address - Phone:678-557-9014
Practice Address - Fax:678-393-9487
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00918904BMedicaid