Provider Demographics
NPI:1023581998
Name:COLEMAN, MARCELLA (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11454 DUNLORING PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5776
Mailing Address - Country:US
Mailing Address - Phone:240-535-6876
Mailing Address - Fax:
Practice Address - Street 1:11454 DUNLORING PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5776
Practice Address - Country:US
Practice Address - Phone:240-535-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist