Provider Demographics
NPI:1881903052
Name:COOPER, ANDREW LOUIS (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LOUIS
Last Name:COOPER
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HALLOCK LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8907
Mailing Address - Country:US
Mailing Address - Phone:631-821-7659
Mailing Address - Fax:
Practice Address - Street 1:76 ROCKY POINT-YAPHANK ROAD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8401
Practice Address - Country:US
Practice Address - Phone:631-744-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist