Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1043720485 |
---|---|
Provider Name | Angelina Coleman |
First Address | Roselle, IL 60172-2570 |
Second Address | Roselle, IL 60172-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2017 |
Last Update Date | 11/10/2017 |