Provider Demographics
NPI:1720659386
Name:KOPP, ZACHARY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:KOPP
Suffix:
Gender:M
Credentials:CCC-SLP
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Mailing Address - Street 1:625 PIEDMONT AVE NE UNIT 3023
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-6209
Mailing Address - Country:US
Mailing Address - Phone:954-612-8015
Mailing Address - Fax:
Practice Address - Street 1:405 ARROWHEAD BLVD STE C
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1254
Practice Address - Country:US
Practice Address - Phone:770-742-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA77315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA77315OtherCOMMONWEALTH OF MASSACHUSETTS BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
14275454OtherAMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION
CA32219OtherSPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY AND HEARING AID DISPENSERS BOARD
GASLP011526OtherSTATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY