Provider Demographics
NPI:1053677963
Name:COOPER, MERCEDES K (MS CCC- SLP)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:K
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120A SANTA MARGARITA AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2725
Mailing Address - Country:US
Mailing Address - Phone:650-324-0648
Mailing Address - Fax:
Practice Address - Street 1:120A SANTA MARGARITA AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2725
Practice Address - Country:US
Practice Address - Phone:650-324-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP#13858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist