Provider Demographics
NPI:1215382726
Name:COLEMAN, KATHY L (SPEECH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SPEECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5754 S HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2004
Mailing Address - Country:US
Mailing Address - Phone:417-224-7397
Mailing Address - Fax:
Practice Address - Street 1:5754 S HILLTOP DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2004
Practice Address - Country:US
Practice Address - Phone:417-224-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODESE183222235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist