MEDICARE: CATHERINE 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	22003196A	IN

General Provider Information

NPI Number	:	1508274762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE COLLINS

Provider Business Mailing Address
First Line	:	4935 HILLEGAS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1934
Country	:	US
Telephone Number	:	260-338-1241
Fax Number	:	260-338-1231

Provider Business Practice Location Address
First Line	:	4935 HILLEGAS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1934
Country	:	US
Telephone Number	:	260-338-1241
Fax Number	:	260-338-1231

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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Directions to “ CATHERINE COLLINS ” Practice Location

Language	Start Address	Practice Location

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