Provider Demographics
NPI:1316943616
Name:COOPER, ELIZABETH COENEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COENEN
Last Name:COOPER
Suffix:
Gender:F
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 1:335 BAHIA LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CARTERET
Mailing Address - State:NC
Mailing Address - Zip Code:28584-9356
Mailing Address - Country:US
Mailing Address - Phone:703-217-3511
Mailing Address - Fax:252-764-2436
Practice Address - Street 1:17028 LEJEUNE ROAD
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-1757
Practice Address - Country:US
Practice Address - Phone:703-217-3511
Practice Address - Fax:703-221-6905
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194110OtherANTHEM BCBS
VA201511442OtherUNITED HEALTHCARE
VA010125961Medicaid
VA2157798OtherMAMSI
VA201511442OtherTRICARE