Provider Demographics
NPI:1922123900
Name:COLEMAN, KELLI ELIZABETH (BSW, LSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ELIZABETH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ELIZABETH
Other - Last Name:SUISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, LSW
Mailing Address - Street 1:21140 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1520
Mailing Address - Country:US
Mailing Address - Phone:440-356-0074
Mailing Address - Fax:
Practice Address - Street 1:3645 WARRENSVILLE CENTER RD
Practice Address - Street 2:#246
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5247
Practice Address - Country:US
Practice Address - Phone:216-295-7239
Practice Address - Fax:216-295-7240
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0029825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker