Provider Demographics
NPI:1477701134
Name:COOPER, KATHERINE (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N BROAD ST
Mailing Address - Street 2:STE 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1553
Mailing Address - Country:US
Mailing Address - Phone:215-790-1553
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 1405
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-790-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41Y00044800231H00000X
PAAT000242L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist