Provider Demographics
NPI:1780870105
Name:COLLINSWORTH, JEREMY L
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:L
Last Name:COLLINSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 N JOSEY LN
Mailing Address - Street 2:STE 125
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2474
Mailing Address - Country:US
Mailing Address - Phone:972-394-4370
Mailing Address - Fax:972-767-4177
Practice Address - Street 1:3740 N JOSEY LN
Practice Address - Street 2:STE 125
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2474
Practice Address - Country:US
Practice Address - Phone:972-394-4370
Practice Address - Fax:972-767-4177
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10648237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist