Provider Demographics
NPI:1700475019
Name:COLLIER, KENDALL L (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:L
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 1:1020 LAUREL CV
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1296
Mailing Address - Country:US
Mailing Address - Phone:678-350-3409
Mailing Address - Fax:
Practice Address - Street 1:460 GRAYSON PKWY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1218
Practice Address - Country:US
Practice Address - Phone:943-456-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist