Provider Demographics
NPI:1104637859
Name:COLEMAN, CORTNEY
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3836
Mailing Address - Country:US
Mailing Address - Phone:419-705-9168
Mailing Address - Fax:419-214-2657
Practice Address - Street 1:636 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3836
Practice Address - Country:US
Practice Address - Phone:419-705-9168
Practice Address - Fax:419-214-2657
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator