Provider Demographics
NPI:1962754416
Name:COLEMAN, LELIA JANETTE
Entity type:Individual
Prefix:MRS
First Name:LELIA
Middle Name:JANETTE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 OLD PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTTSWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24476-2134
Mailing Address - Country:US
Mailing Address - Phone:540-377-5166
Mailing Address - Fax:
Practice Address - Street 1:582 OLD PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:SPOTTSWOOD
Practice Address - State:VA
Practice Address - Zip Code:24476-2134
Practice Address - Country:US
Practice Address - Phone:540-377-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist