Doctor Name: | TERESA RAE KOPPANG |
NPI Number: | 1881865426 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCCSLP |
License Number: | 8187 |
Business Practice Address: | 900 W 94th St Bloomington, MN - 55420 |
Business Phone Number: | 9528850418 |
Business Fax Number: | 9528850173 |
Mailing Address: | 900 W 94th St, BLOOMINGTON |
State: | MN |
Postal Code: | 55420 |
Phone Number: | 9528850418 |
Fax Number: | 9528850173 |
NPI Enumeration Date: | 03/21/2008 |
NPI Last Update Date: | 03/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 8187 |
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 |