Provider Demographics
NPI:1427024371
Name:COLEMAN, ANGELA KAY (CCC-A)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 W REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8936
Mailing Address - Country:US
Mailing Address - Phone:479-636-0110
Mailing Address - Fax:479-631-0491
Practice Address - Street 1:5204 W REDBUD ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8936
Practice Address - Country:US
Practice Address - Phone:479-636-0110
Practice Address - Fax:479-631-0491
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA178231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142916720Medicaid