Provider Demographics
NPI:1760173470
Name:COOPER, AIMEEROSE
Entity Type:Individual
Prefix:
First Name:AIMEEROSE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIMEEROSE
Other - Middle Name:COOPER
Other - Last Name:OLDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:750 E 1350 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7764
Mailing Address - Country:US
Mailing Address - Phone:385-477-9980
Mailing Address - Fax:
Practice Address - Street 1:556 E 300 S
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3844
Practice Address - Country:US
Practice Address - Phone:801-980-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
UT1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker