Provider Demographics
NPI:1215129457
Name:COLEMAN, THOMAS RUSSELL (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 LASAINE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2420
Mailing Address - Country:US
Mailing Address - Phone:818-564-2781
Mailing Address - Fax:
Practice Address - Street 1:10801 LINDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4441
Practice Address - Country:US
Practice Address - Phone:818-275-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist