Provider Demographics
NPI:1619195930
Name:COLLINS, MARY MICHELLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2806 LYNDALE LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1440
Mailing Address - Country:US
Mailing Address - Phone:406-652-1064
Mailing Address - Fax:
Practice Address - Street 1:1415 YELLOWSTONE RIVER RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1834
Practice Address - Country:US
Practice Address - Phone:406-245-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist