Provider Demographics
NPI:1508163379
Name:COLEMAN, PEGGIE ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGIE
Middle Name:ANN
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:PO BOX 3667
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3667
Mailing Address - Country:US
Mailing Address - Phone:662-680-3148
Mailing Address - Fax:
Practice Address - Street 1:1122 N ESHMAN AVE
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-5436
Practice Address - Country:US
Practice Address - Phone:662-494-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist