Provider Demographics
NPI:1659536506
Name:COOPER, MARIE DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:DIANE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 MIDLAND TURN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5367
Mailing Address - Country:US
Mailing Address - Phone:202-386-8745
Mailing Address - Fax:301-868-6212
Practice Address - Street 1:9308 MIDLAND TURN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5367
Practice Address - Country:US
Practice Address - Phone:202-386-7745
Practice Address - Fax:301-868-6212
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01017829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist