Healthcare Provider Details

I. General information

NPI: 1770400343
Provider Name (Legal Business Name): ASHLEY COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 MILLER AVE
GARY IN
46403-2469
US

IV. Provider business mailing address

16815 BROADWAY ST
LOWELL IN
46356-7105
US

V. Phone/Fax

Practice location:
  • Phone: 219-427-0196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number29001841A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: