Provider Demographics
NPI:1225186455
Name:COLEMAN, GEORGANN (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGANN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MRS
Other - First Name:GEORG
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCCSLP
Mailing Address - Street 1:2036 W HURON
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:773-507-6952
Mailing Address - Fax:
Practice Address - Street 1:2036 W HURON ST
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1427
Practice Address - Country:US
Practice Address - Phone:773-507-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist