Provider Demographics
NPI:1477074078
Name:COLLINS, CARLA SUE
Entity type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:SUE
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 1:511 S GRAHAM AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3377
Mailing Address - Country:US
Mailing Address - Phone:618-262-6283
Mailing Address - Fax:
Practice Address - Street 1:22 VETERANS DRIVE
Practice Address - Street 2:P.O. BOX 869
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-6294
Practice Address - Country:US
Practice Address - Phone:618-252-0377
Practice Address - Fax:618-252-2389
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist