Provider Demographics
NPI:1205587565
Name:COLEMAN, DE'SHAUNTE BRIANA
Entity type:Individual
Prefix:
First Name:DE'SHAUNTE
Middle Name:BRIANA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SHERWOOD COMMON BLVD APT 1416
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4276
Mailing Address - Country:US
Mailing Address - Phone:225-603-4639
Mailing Address - Fax:
Practice Address - Street 1:8000 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8417
Practice Address - Country:US
Practice Address - Phone:225-927-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist