Provider Demographics
NPI:1700243409
Name:COLEMAN, ROCHELLE WEIKERS (EDS)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:WEIKERS
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9356 HOCKING ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9046
Mailing Address - Country:US
Mailing Address - Phone:330-265-1913
Mailing Address - Fax:
Practice Address - Street 1:12000 NAVARRE RD SW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-9486
Practice Address - Country:US
Practice Address - Phone:330-767-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHKU1001769103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool