Provider Demographics
NPI:1073365532
Name:COLEMAN, GIA (CBCS)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CBCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 W LAWRENCE AVE UNIT 300861
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11009 S WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4220
Practice Address - Country:US
Practice Address - Phone:773-912-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information