Provider Demographics
NPI:1568070522
Name:COOPER, CHELSEY BROOKE LYNN
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:BROOKE LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KY HIGHWAY 590
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-8279
Mailing Address - Country:US
Mailing Address - Phone:606-706-7645
Mailing Address - Fax:
Practice Address - Street 1:530 PERRYVILLE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2012
Practice Address - Country:US
Practice Address - Phone:859-733-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist