Healthcare Provider Details

I. General information

NPI: 1780543280
Provider Name (Legal Business Name): PHYLLIS ANDREA COLLAR MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N LAWE ST
APPLETON WI
54911-5518
US

IV. Provider business mailing address

229 N LAWE ST
APPLETON WI
54911-5518
US

V. Phone/Fax

Practice location:
  • Phone: 920-422-3899
  • Fax:
Mailing address:
  • Phone: 920-422-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8156-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: