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General NPI Number Information
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NPI Number | 1093332363
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Entity Type | Individual
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Provider Name | KELLY ANN COLEMAN
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 6830 COCHRAN RD
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City | SOLON
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State | OH
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Zip | 44139-3966
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Country | US
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Telephone | 216-282-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 2461 W 25TH ST UNIT 314
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City | CLEVELAND
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State | OH
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Zip | 44113-5604
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Country | US
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Telephone | 317-695-7687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-72401
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License Number State | OH
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