MEDICARE: MS. KIMBERLY RENAE COLEMAN M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	S2900	MS

General Provider Information

NPI Number	:	1407832678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY RENAE COLEMAN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1662 DEBRA DR.
Second Line	:	COLEMAN SPEECH & LANGUAGE SERVICES, LLC
City	:	GREENVILLE
State	:	MS
Zip	:	38703
Country	:	US
Telephone Number	:	662-347-0830
Fax Number	:	662-537-7887

Provider Business Practice Location Address
First Line	:	1662 DEBRA DR.
Second Line	:	COLEMAN SPEECH & LANGUAGE SERVICES, LLC
City	:	GREENVILLE
State	:	MS
Zip	:	38703
Country	:	US
Telephone Number	:	662-347-0830
Fax Number	:	662-537-7887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	04/13/2011

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