Provider Demographics
NPI:1891703815
Name:COLEMAN, TONYA RENEE (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RENEE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11332 APPLEJACK RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-3246
Mailing Address - Country:US
Mailing Address - Phone:423-360-4052
Mailing Address - Fax:
Practice Address - Street 1:103 NORTH ST
Practice Address - Street 2:SUITE B BRISTOL REGIONAL SPEECH & HEARING CENTER
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3201
Practice Address - Country:US
Practice Address - Phone:276-669-6331
Practice Address - Fax:276-669-2950
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4088622OtherBCBS
324194OtherANTHEM
496511Medicare ID - Type Unspecified