MEDICARE: MADELINE COLLINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1023810512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE COLLINS

Provider Business Mailing Address
First Line	:	8101 BOAT CLUB RD STE 240-319
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3630
Country	:	US
Telephone Number	:	682-498-3928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 CLEAR LAKE RD STE 200
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-8801
Country	:	US
Telephone Number	:	682-271-1720
Fax Number	:	214-935-2457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	10/07/2025

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Directions to “ MADELINE COLLINS ” Practice Location

Language	Start Address	Practice Location

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