Provider Demographics
NPI:1568205094
Name:EAGEN, COLLIN MCHENRY (SLP)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:MCHENRY
Last Name:EAGEN
Suffix:
Gender:X
Credentials:SLP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:EAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1713 SPRINGMEADOWS CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1162
Mailing Address - Country:US
Mailing Address - Phone:970-800-1527
Mailing Address - Fax:
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0001292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist