MEDICARE: DR. JENNIFER COLEMAN PHD

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	103TC0700X	Clinical Psychologist	071.010591	IL

General Provider Information

NPI Number	:	1972989051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER COLEMAN PHD

Provider Business Mailing Address
First Line	:	332 S. MICHIGAN AVE.
Second Line	:	STE 121 #5151
City	:	CHICAGO
State	:	IL
Zip	:	60604
Country	:	US
Telephone Number	:	858-243-6812
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 1626
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3740
Country	:	US
Telephone Number	:	858-243-6812
Fax Number	:

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

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	11/03/2022

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