Basic Information
| Provider Information | |||||||||
| NPI: | 1053359497 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPPINGER | ||||||||
| FirstName: | JODIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CASHEN | ||||||||
| OtherFirstName: | JODIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE LN N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554463706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883339152 | ||||||||
| FaxNumber: | 7632684240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 CENTRAL ST | ||||||||
| Address2: | STE 717 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476745247 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | IL | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.