Provider Demographics
NPI:1629400916
Name:COLEMAN, LAKISHA NICHOLS (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:NICHOLS
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 PEARLIE OWENS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3273
Mailing Address - Country:US
Mailing Address - Phone:601-597-0681
Mailing Address - Fax:
Practice Address - Street 1:249 PEARLIE OWENS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3273
Practice Address - Country:US
Practice Address - Phone:601-597-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist