Provider Demographics
NPI:1972664746
Name:COOPER, CAROLYN RAE (MA CCCA)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RAE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:RAE
Other - Last Name:VROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCCA
Mailing Address - Street 1:3180 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3701
Mailing Address - Country:US
Mailing Address - Phone:916-977-3277
Mailing Address - Fax:916-977-3275
Practice Address - Street 1:3180 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-977-3274
Practice Address - Fax:916-977-3275
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU462231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist