Provider Demographics
NPI:1508102484
Name:COPPEDGE, HADIYA K (MS CCC,SLP)
Entity Type:Individual
Prefix:
First Name:HADIYA
Middle Name:K
Last Name:COPPEDGE
Suffix:
Gender:F
Credentials:MS CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1810
Mailing Address - Country:US
Mailing Address - Phone:804-519-2845
Mailing Address - Fax:
Practice Address - Street 1:8710 EMGE RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3504
Practice Address - Country:US
Practice Address - Phone:804-519-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08081235Z00000X
VA2202006163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist