Basic Information
| Provider Information | |||||||||
| NPI: | 1912165283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 CHERRY BARK WAY UNIT 23 | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307211956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062264623 | ||||||||
| FaxNumber: | 7062780580 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 PROFESSIONAL BLVD | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307202506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062264623 | ||||||||
| FaxNumber: | 7062780580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 006856 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.