Provider Demographics
NPI:1861058059
Name:COLEMAN-WATERBURY, TRICIA JANE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:JANE
Last Name:COLEMAN-WATERBURY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 FLINTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-4305
Mailing Address - Country:US
Mailing Address - Phone:602-402-1178
Mailing Address - Fax:
Practice Address - Street 1:506 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-1748
Practice Address - Country:US
Practice Address - Phone:319-559-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0849361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical