Provider Demographics
NPI:1356787220
Name:COLLINS, AMI JOLENE (SLP)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:JOLENE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 AVIATION DR
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9037
Mailing Address - Country:US
Mailing Address - Phone:509-885-8293
Mailing Address - Fax:
Practice Address - Street 1:2553 AVIATION DR
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-9037
Practice Address - Country:US
Practice Address - Phone:509-885-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60365729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist