Provider Demographics
NPI:1538786264
Name:COLLINS, SHANNON A (MS SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 S QUEBEC ST APT T204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2673
Mailing Address - Country:US
Mailing Address - Phone:970-618-2018
Mailing Address - Fax:
Practice Address - Street 1:4400 S QUEBEC ST APT T204
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2673
Practice Address - Country:US
Practice Address - Phone:970-618-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP12470235Z00000X
COSLP.0004826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist