Provider Demographics
NPI:1932655370
Name:COLEMAN, AMY JK (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JK
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NORTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4322
Mailing Address - Country:US
Mailing Address - Phone:484-554-5304
Mailing Address - Fax:
Practice Address - Street 1:701 OSTRUM ST STE 303
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:484-526-4439
Practice Address - Fax:484-526-3908
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGC000247170300000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS