Provider Demographics
NPI:1215686910
Name:COLEMAN, ALEXANDRA ANNA (SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANNA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LOGAN ST STE M
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-2908
Mailing Address - Country:US
Mailing Address - Phone:828-559-2164
Mailing Address - Fax:
Practice Address - Street 1:29 LOGAN ST STE M
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-2908
Practice Address - Country:US
Practice Address - Phone:828-559-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist