Provider Demographics
NPI:1285814442
Name:COOPER, CHRISTY HELEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:HELEN
Last Name:COOPER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 SOTOYOME STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-528-0565
Mailing Address - Fax:707-528-6403
Practice Address - Street 1:196 SOTOYOME ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4800
Practice Address - Country:US
Practice Address - Phone:707-528-0565
Practice Address - Fax:707-528-6403
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2418231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist