Healthcare Provider Details

I. General information

NPI: 1033705348
Provider Name (Legal Business Name): ERICA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MCDOWELL RD 101
NAPERVILLE IL
60563
US

IV. Provider business mailing address

1975 MCDOWELL RD 101
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 331-229-8839
  • Fax:
Mailing address:
  • Phone: 331-229-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69352
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: