Provider Demographics
NPI:1871260067
Name:COOPER, MOLLY DEE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DEE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 DYER RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7489
Mailing Address - Country:US
Mailing Address - Phone:925-819-6836
Mailing Address - Fax:
Practice Address - Street 1:1600 LOS GAMOS DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1807
Practice Address - Country:US
Practice Address - Phone:415-209-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist