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CHRISTINA MARIE COOPER CCC,SLP
>> Speech-Language Pathologist >> Speech, Language and Hearing Service ProvidersRegistrant NPI Number: 1366967721
Individual Registrant: CHRISTINA MARIE COOPER CCC,SLP
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
611 S GRANT ST FITZGERALD, GA 31750-3377 US
Tel: 912-331-0846 Fax: 678-792-4894
Tel: 912-331-0846 Fax: 678-792-4894
Contact information for business:
118 PEARL AVE N DOUGLAS, GA 31533-4632 US
Tel: 912-331-0846 Fax: 678-792-4894
Tel: 912-331-0846 Fax: 678-792-4894
Registration Information:
NPI: 1366967721
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 235Z00000X | Speech, Language and Hearing Service Providers Speech-Language Pathologist | GA | SLP009947 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| ASHA | 14149731 | GA | 01 |
| STATE LICENSE | PCET002459 | GA | 01 |
| STATE LICENSE | SLP009947 | GA | 01 |
