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NPI Code Detail

MEDICARE: MR. COLTEN DEAN COFFIN MA, LCSW

MEDICARE: MR. COLTEN DEAN COFFIN MA, LCSW
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
1104100000XSocial Worker150102660IL
21041C0700XClinical Social Worker149021134IL

General Provider Information

NPI Number : 1891208419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COLTEN DEAN COFFIN MA, LCSW
Provider Business Mailing Address
First Line : 1132 W ARGYLE ST # 2E
Second Line :
City : CHICAGO
State : IL
Zip : 60640-3610
Country : US
Telephone Number : 312-213-4871
Fax Number :
Provider Business Practice Location Address
First Line : 12145 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-1387
Country : US
Telephone Number : 773-537-3992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2017
Last Update Date : 04/09/2019

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