Provider Demographics
NPI:1942807508
Name:COOPER, MEREDITH L (HIS)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-1262
Mailing Address - Country:US
Mailing Address - Phone:570-473-1200
Mailing Address - Fax:570-473-3300
Practice Address - Street 1:596 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-1262
Practice Address - Country:US
Practice Address - Phone:570-473-1200
Practice Address - Fax:570-473-3300
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03669237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist