Healthcare Provider Details

I. General information

NPI: 1265345193
Provider Name (Legal Business Name): REBECCA COLEMAN MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 CUSHING RD
SAN DIEGO CA
92106-6189
US

IV. Provider business mailing address

4773 MISSION BLVD APT N
SAN DIEGO CA
92109-2545
US

V. Phone/Fax

Practice location:
  • Phone: 318-294-7222
  • Fax:
Mailing address:
  • Phone: 318-294-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: