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General NPI Number Information
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NPI Number | 1477074078
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Entity Type | Individual
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Provider Name | MISS CARLA SUE COLLINS
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Gender | Female
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 22 VETERANS DRIVE P.O. BOX 869
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City | HARRISBURG
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State | IL
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Zip | 62946-6294
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Country | US
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Telephone | 618-252-0377
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Fax | 618-252-2389
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Provider Business Mailing Address
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Address Line | 511 S GRAHAM AVE APT 310
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City | CARBONDALE
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State | IL
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Zip | 62901-3377
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Country | US
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Telephone | 618-262-6283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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