Organization Name: | KELLY COOPER, LLC |
NPI Number: | 1538580436 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY COOPER (SPEECH LANGUAGE PATHOLOGIST) |
Mailing Address: | 1300 W Medicine Lake Dr #321 Plymouth |
State: | MN US |
Postal Code: | 554414859 |
Phone Number: | 3202937827 |
Fax Number: | |
NPI Enumeration Date: | 12/18/2013 |
NPI Last Update Date: | 12/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 9027 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |