Provider Demographics
NPI:1720639222
Name:COLLINS, ANN MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
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 1:4320 STATE ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:13121
Mailing Address - Country:US
Mailing Address - Phone:315-963-8400
Mailing Address - Fax:
Practice Address - Street 1:4320 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:NY
Practice Address - Zip Code:13121
Practice Address - Country:US
Practice Address - Phone:315-963-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist