Provider Demographics
NPI:1497966345
Name:COOPER, DAWN ANN (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:COOPER
Other - Middle Name:THERAPY
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:897 JOHN ENGLAND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41004
Mailing Address - Country:US
Mailing Address - Phone:859-588-8160
Mailing Address - Fax:606-724-2448
Practice Address - Street 1:897 JOHN ENGLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41004
Practice Address - Country:US
Practice Address - Phone:859-588-8160
Practice Address - Fax:606-724-2448
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
KY235Z00000X
KY1509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist