Provider Demographics
NPI:1699172445
Name:COLEMAN, RYAN (MS SLP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
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 1:8903 36TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2116
Mailing Address - Country:US
Mailing Address - Phone:503-933-6501
Mailing Address - Fax:
Practice Address - Street 1:16715 36TH AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-1376
Practice Address - Country:US
Practice Address - Phone:253-683-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA511426R235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist