Provider Demographics
NPI:1124234984
Name:COPELAND, LISA COOPER (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:COOPER
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:BROOKE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 29
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37364-0029
Mailing Address - Country:US
Mailing Address - Phone:423-472-5268
Mailing Address - Fax:423-614-5466
Practice Address - Street 1:764 OLD CHATTANOOGA PIKE SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-472-5268
Practice Address - Fax:423-614-5466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist