Provider Demographics
NPI:1275264053
Name:COLEMAN, FELICIA COLLETTE (SLP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:COLLETTE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 GUINEVERE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-6430
Mailing Address - Country:US
Mailing Address - Phone:321-505-2893
Mailing Address - Fax:
Practice Address - Street 1:4083 US HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5308
Practice Address - Country:US
Practice Address - Phone:321-505-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty