Provider Demographics
NPI:1780363796
Name:COLEMAN, JACALYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACALYN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44425 GOV BRADFORD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3741
Mailing Address - Country:US
Mailing Address - Phone:734-564-3535
Mailing Address - Fax:
Practice Address - Street 1:44425 GOV BRADFORD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3741
Practice Address - Country:US
Practice Address - Phone:734-564-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist