Provider Demographics
NPI:1649028366
Name:COLLINS, JENNIFER KAY (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9777
Mailing Address - Country:US
Mailing Address - Phone:712-540-2550
Mailing Address - Fax:
Practice Address - Street 1:4820 ROBIN LN
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9777
Practice Address - Country:US
Practice Address - Phone:712-540-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health