Provider Demographics
NPI:1376931857
Name:COLEMAN, JAHAHN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAHAHN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 METCALF ST
Mailing Address - Street 2:APT 2
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4426
Mailing Address - Country:US
Mailing Address - Phone:773-505-0154
Mailing Address - Fax:
Practice Address - Street 1:25 LINDEN AVE
Practice Address - Street 2:APT 12
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2253
Practice Address - Country:US
Practice Address - Phone:773-505-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist