MEDICARE: MS. PAMELA LYNN COLLINS M.S., CCC-SLP

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	SLP004872	GA

General Provider Information

NPI Number	:	1386752152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA LYNN COLLINS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2410 KINGSLAND DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30360-1442
Country	:	US
Telephone Number	:	678-248-1692
Fax Number	:	678-248-1693

Provider Business Practice Location Address
First Line	:	2410 KINGSLAND DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30360-1442
Country	:	US
Telephone Number	:	678-248-1692
Fax Number	:	678-248-1693

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. PAMELA LYNN COLLINS M.S., CCC-SLP” Practice Location

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