Individual
JADE COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, MHP
Contact information
Practice address
901 W 33RD ST, CHICAGO, IL 60608-6647
(773) 416-5233
Mailing address
901 W 33RD ST, CHICAGO, IL 60608-6647
(773) 416-5233
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101Y00000X
—
IL
05
—
103K00000X
—
IL
05
—
174400000X
—
IL
Enumeration date
01/18/2012
Last updated
01/18/2012
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