Provider Demographics
NPI:1194999599
Name:COLEMAN, PAUL MICHAEL (SLP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials: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 2375
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502
Mailing Address - Country:US
Mailing Address - Phone:606-434-6153
Mailing Address - Fax:
Practice Address - Street 1:205 LEFT FORK OF ISLAND CRK
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-7236
Practice Address - Country:US
Practice Address - Phone:606-434-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist