Healthcare Provider Details

I. General information

NPI: 1790696193
Provider Name (Legal Business Name): GINA COLLINS M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1406
ANN ARBOR MI
48106-1406
US

IV. Provider business mailing address

PO BOX 1406
ANN ARBOR MI
48106-1406
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-8100
  • Fax: 734-436-2948
Mailing address:
  • Phone: 734-994-8100
  • Fax: 734-436-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005704
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: