Provider Demographics
NPI:1518776319
Name:COOPER, LEANN MALLONEE (ST)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:MALLONEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:MALLONEE
Other - Last Name:PICKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4138
Mailing Address - Country:US
Mailing Address - Phone:480-375-2935
Mailing Address - Fax:
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4138
Practice Address - Country:US
Practice Address - Phone:480-375-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty