Provider Demographics
NPI:1114200284
Name:COOPER, JOCELYN M (ND)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62866 BILYEU WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7024
Mailing Address - Country:US
Mailing Address - Phone:206-707-3963
Mailing Address - Fax:
Practice Address - Street 1:464 NE NORTON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4387
Practice Address - Country:US
Practice Address - Phone:541-323-3358
Practice Address - Fax:541-323-3359
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
WA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath