Provider Demographics
NPI:1356867626
Name:COPELAND, LYNETTE PATRICE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:PATRICE
Last Name:COPELAND
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 1:4222 INVERRARY BLVD APT 4811
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4164
Mailing Address - Country:US
Mailing Address - Phone:954-934-7312
Mailing Address - Fax:
Practice Address - Street 1:1901 AVENUE S
Practice Address - Street 2:1901 AVENUE S
Practice Address - City:RIVERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-845-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14220423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist