Provider Demographics
NPI:1366185860
Name:COLLECTIVE THERAPY
Entity type:Organization
Organization Name:COLLECTIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:VUONG
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:314-482-1275
Mailing Address - Street 1:5377 HIGHWAY N STE 424
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8032
Mailing Address - Country:US
Mailing Address - Phone:314-482-1275
Mailing Address - Fax:
Practice Address - Street 1:5377 HIGHWAY N STE 424
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304-8032
Practice Address - Country:US
Practice Address - Phone:314-482-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech