Provider Demographics
NPI:1346027091
Name:COPELAND, MARY (MCD, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 METHODIST CAMP LOOP
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-7696
Mailing Address - Country:US
Mailing Address - Phone:662-910-9881
Mailing Address - Fax:
Practice Address - Street 1:6245 HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:COTTON VALLEY
Practice Address - State:LA
Practice Address - Zip Code:71018-3164
Practice Address - Country:US
Practice Address - Phone:318-832-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist