Provider Demographics
NPI:1700914488
Name:COOPER, DYAN ALLISON (MA - CCC)
Entity Type:Individual
Prefix:MISS
First Name:DYAN
Middle Name:ALLISON
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA - CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LAKE POINTE DR
Mailing Address - Street 2:UNIT #206
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-7707
Mailing Address - Country:US
Mailing Address - Phone:754-224-7647
Mailing Address - Fax:
Practice Address - Street 1:4988 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5748
Practice Address - Country:US
Practice Address - Phone:954-746-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist