Provider Demographics
NPI:1508311820
Name:COLEMAN, NOELLE III (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:COLEMAN
Suffix:III
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 S DELAWARE CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1829
Mailing Address - Country:US
Mailing Address - Phone:918-850-6368
Mailing Address - Fax:
Practice Address - Street 1:2240 S DELAWARE CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1829
Practice Address - Country:US
Practice Address - Phone:918-850-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1508311820Medicaid