Provider Demographics
NPI:1407228729
Name:COOPER, CECELIA (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 E COMMERCIAL BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4216
Mailing Address - Country:US
Mailing Address - Phone:954-804-0298
Mailing Address - Fax:
Practice Address - Street 1:2821 E COMMERCIAL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4216
Practice Address - Country:US
Practice Address - Phone:954-804-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist