MEDICARE: ELIZABETH COLEMAN

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	146004864	IL

General Provider Information

NPI Number	:	1649624073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH COLEMAN

Provider Business Mailing Address
First Line	:	450 E FULTON ST
Second Line	:
City	:	PAXTON
State	:	IL
Zip	:	60957-1716
Country	:	US
Telephone Number	:	217-379-2116
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E FULTON ST
Second Line	:
City	:	PAXTON
State	:	IL
Zip	:	60957-1716
Country	:	US
Telephone Number	:	217-379-2116
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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Directions to “ ELIZABETH COLEMAN ” Practice Location

Language	Start Address	Practice Location

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