Provider Demographics
NPI:1174749048
Name:COOPER, STEPHANIE MARIE (MS CCCSLP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26702 STAGECOACH CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-2198
Mailing Address - Country:US
Mailing Address - Phone:832-934-2258
Mailing Address - Fax:
Practice Address - Street 1:18230 FM 1488 RD # 328
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4528
Practice Address - Country:US
Practice Address - Phone:936-689-3874
Practice Address - Fax:830-460-2685
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87716TOtherBCBS TX
TX147146802Medicaid