Basic Information
| Provider Information | |||||||||
| NPI: | 1659631760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | COLETTE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PH. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 677 ALA MOANA BLVD | ||||||||
| Address2: | SUITE 625 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086921580 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 677 ALA MOANA BLVD | ||||||||
| Address2: | SUITE 625 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086921580 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2012 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 800 | HI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.