Provider Demographics
NPI:1851568992
Name:COLEMAN, SUSAN ELAINE (MA FAAA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 SHADY GROVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6352
Mailing Address - Country:US
Mailing Address - Phone:301-315-0003
Mailing Address - Fax:301-315-0002
Practice Address - Street 1:15001 SHADY GROVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6352
Practice Address - Country:US
Practice Address - Phone:301-315-0003
Practice Address - Fax:301-315-0002
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00502231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist