Provider Demographics
NPI:1558879825
Name:COOPER, MARIE ANN (CO60824351)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:CO60824351
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 ADDY LOOP
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2748
Mailing Address - Country:US
Mailing Address - Phone:360-356-4579
Mailing Address - Fax:
Practice Address - Street 1:11719 NE 95TH ST STE D
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-2444
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:360-397-8455
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator