Provider Demographics
NPI:1609202944
Name:COOPER, KELLY O (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:O
Last Name:COOPER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:O'STEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:30207 FRANKFORD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-2616
Mailing Address - Country:US
Mailing Address - Phone:302-732-3800
Mailing Address - Fax:302-732-6016
Practice Address - Street 1:31 HOSIER ST
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975
Practice Address - Country:US
Practice Address - Phone:302-732-3800
Practice Address - Fax:302-732-6016
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0001340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist