Provider Demographics
NPI:1245799535
Name:COLEMAN, BOBBIE JO
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JO
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 CRIMSON ST
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-4223
Mailing Address - Country:US
Mailing Address - Phone:307-388-2060
Mailing Address - Fax:
Practice Address - Street 1:1615 CRIMSON ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-4223
Practice Address - Country:US
Practice Address - Phone:307-388-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child