Provider Demographics
NPI:1598388357
Name:COLEMAN, CORINNE KATHLEEN (AUD CCC-A, F-AA)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:KATHLEEN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:AUD CCC-A, F-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13455 W BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1344
Mailing Address - Country:US
Mailing Address - Phone:208-631-4303
Mailing Address - Fax:
Practice Address - Street 1:1182 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2130
Practice Address - Country:US
Practice Address - Phone:541-881-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist