Provider Demographics
NPI:1841508686
Name:NOBLE, CORAL (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MS 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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-0721
Mailing Address - Country:US
Mailing Address - Phone:904-415-3229
Mailing Address - Fax:
Practice Address - Street 1:122 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-1702
Practice Address - Country:US
Practice Address - Phone:970-842-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9351235Z00000X
CASP 18385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist