Provider Demographics
NPI:1437881430
Name:COPPEDGE, MARY OLIVER (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARY OLIVER
Middle Name:
Last Name:COPPEDGE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 RIVER LANDING DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8894
Mailing Address - Country:US
Mailing Address - Phone:870-278-3189
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 113
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist