Provider Demographics
NPI:1164773008
Name:COLEMAN, ANGELA RENEE (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:RENEE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3317 ROYAL SCOTS WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9327
Mailing Address - Country:US
Mailing Address - Phone:479-646-6560
Mailing Address - Fax:479-965-2723
Practice Address - Street 1:3010 HIGHWAY 22 E
Practice Address - Street 2:SUITE A
Practice Address - City:BRANCH
Practice Address - State:AR
Practice Address - Zip Code:72928-9648
Practice Address - Country:US
Practice Address - Phone:479-965-2191
Practice Address - Fax:479-965-2723
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist