Provider Demographics
NPI:1720470396
Name:COOPER-KUNKEL, KENDALL (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:
Last Name:COOPER-KUNKEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HELENE CT
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8375
Mailing Address - Country:US
Mailing Address - Phone:570-691-7915
Mailing Address - Fax:
Practice Address - Street 1:101 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:866-745-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist