Provider Demographics
NPI:1427366996
Name:COOPER, SHIRLEY ALIECE (MA-SP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ALIECE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA-SP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13931 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1632
Mailing Address - Country:US
Mailing Address - Phone:818-367-7970
Mailing Address - Fax:
Practice Address - Street 1:13931 TYLER ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1632
Practice Address - Country:US
Practice Address - Phone:818-367-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist