Provider Demographics
NPI:1063702256
Name:COPPAKEN, BLAINE LAUREN (SLP)
Entity type:Individual
Prefix:MRS
First Name:BLAINE
Middle Name:LAUREN
Last Name:COPPAKEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13149 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2917
Mailing Address - Country:US
Mailing Address - Phone:913-558-4148
Mailing Address - Fax:
Practice Address - Street 1:5211 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-3154
Practice Address - Country:US
Practice Address - Phone:913-383-2569
Practice Address - Fax:913-383-2611
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2975231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist