MEDICARE: BETHANIE JOY COLEMAN M.A. 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	SL011197	PA
2	235Z00000X	Speech-Language Pathologist	146011489	IL

General Provider Information

NPI Number	:	1871832147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANIE JOY COLEMAN M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	353 N DESPLAINES ST
Second Line	:	APT 3109
City	:	CHICAGO
State	:	IL
Zip	:	60661-1234
Country	:	US
Telephone Number	:	215-435-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 N DESPLAINES ST
Second Line	:	APT 3109
City	:	CHICAGO
State	:	IL
Zip	:	60661-1234
Country	:	US
Telephone Number	:	215-435-4326
Fax Number	:

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

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	04/22/2013

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Directions to “ BETHANIE JOY COLEMAN M.A. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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