Provider Demographics
NPI:1760462576
Name:COOLEY, KATHLEEN S (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:S
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 CERTIFICATE COURT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29414
Mailing Address - Country:US
Mailing Address - Phone:843-628-6118
Mailing Address - Fax:
Practice Address - Street 1:788 CERTIFICATE COURT
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-628-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist