Provider Demographics
NPI:1992176598
Name:COLEMAN, ALEXANDRA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
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 1:346 RHEEM BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1503
Mailing Address - Country:US
Mailing Address - Phone:925-268-0081
Mailing Address - Fax:
Practice Address - Street 1:346 RHEEM BLVD
Practice Address - Street 2:STE 105
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1503
Practice Address - Country:US
Practice Address - Phone:925-268-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist