Provider Demographics
NPI:1104326255
Name:CORONEL, MOMILANI DEANN (STASSISTANT)
Entity type:Individual
Prefix:
First Name:MOMILANI
Middle Name:DEANN
Last Name:CORONEL
Suffix:
Gender:F
Credentials:STASSISTANT
Other - Prefix:
Other - First Name:MOMILANI
Other - Middle Name:DEANN
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STASSISTANT
Mailing Address - Street 1:PO BOX 177545
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75017-7545
Mailing Address - Country:US
Mailing Address - Phone:469-990-6318
Mailing Address - Fax:
Practice Address - Street 1:1613 WILDERNESS TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2028
Practice Address - Country:US
Practice Address - Phone:469-990-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant