Provider Demographics
NPI:1982975264
Name:COLEMAN, DONNA GAIL (MS, SLP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GAIL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9576
Mailing Address - Country:US
Mailing Address - Phone:360-359-8544
Mailing Address - Fax:
Practice Address - Street 1:7600 MICHAEL LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9576
Practice Address - Country:US
Practice Address - Phone:360-359-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005375A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist