Provider Demographics
NPI:1578189163
Name:COLEMAN-SMITH, YOLANDA YVETTE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:YVETTE
Last Name:COLEMAN-SMITH
Suffix:
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:PO BOX 37894
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-7894
Mailing Address - Country:US
Mailing Address - Phone:318-349-1031
Mailing Address - Fax:
Practice Address - Street 1:650 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2210
Practice Address - Country:US
Practice Address - Phone:318-537-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist