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General NPI Number Information
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NPI Number | 1659492486
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Entity Type | Individual
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Provider Name | MR. WILLIAM JOHN COLEMAN
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 MENDOTA RD W SUITE 300
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City | SAINT PAUL
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State | MN
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Zip | 55118-4764
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Country | US
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Telephone | 651-554-6438
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Fax | 651-554-6043
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Provider Business Mailing Address
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Address Line | 1115 ELWAY ST # 303
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City | SAINT PAUL
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State | MN
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Zip | 55116-3244
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Country | US
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Telephone | 612-414-0600
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Fax | 651-554-6043
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16396
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License Number State | MN
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