Basic Information
| Provider Information | |||||||||
| NPI: | 1609202944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | O'STEEN | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 30207 FRANKFORD SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | FRANKFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199452616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027323800 | ||||||||
| FaxNumber: | 3027326016 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 HOSIER ST | ||||||||
| Address2: | |||||||||
| City: | SELBYVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027323800 | ||||||||
| FaxNumber: | 3027326016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2013 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 01-0001340 | DE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.