Provider Demographics
NPI:1730800145
Name:COOPER SPEECH SERVICES LLC
Entity type:Organization
Organization Name:COOPER SPEECH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:478-494-6743
Mailing Address - Street 1:3502 POLLETT RD
Mailing Address - Street 2:
Mailing Address - City:WADLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30477-3538
Mailing Address - Country:US
Mailing Address - Phone:478-469-3557
Mailing Address - Fax:
Practice Address - Street 1:3502 POLLETT RD
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:GA
Practice Address - Zip Code:30477-3538
Practice Address - Country:US
Practice Address - Phone:478-469-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty