Provider Demographics
NPI:1376790550
Name:COPPA, ETHEL (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:
Last Name:COPPA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:MISS
Other - First Name:ETHEL
Other - Middle Name:
Other - Last Name:NATOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:12 GERE TERRACE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:610-348-8816
Mailing Address - Fax:
Practice Address - Street 1:97 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3617
Practice Address - Country:US
Practice Address - Phone:856-334-5161
Practice Address - Fax:856-574-4661
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00477600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist