Provider Demographics
NPI:1578110680
Name:COOPER, EMILY E (AUD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:COOPER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:E
Other - Last Name:BUENTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:8600 IL ROUTE 91
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-691-6616
Mailing Address - Fax:
Practice Address - Street 1:8600 IL ROUTE 91
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-691-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001724231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147001724OtherIL