Basic Information
Provider Information
NPI: 1952438764
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COOPER
FirstName: CYNTHIA
MiddleName: DAWN
NamePrefix:  
NameSuffix:  
Credential: MSCCCSLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3183 CHURCHVIEW AVE
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152274342
CountryCode: US
TelephoneNumber: 4126135764
FaxNumber:  
Practice Location
Address1: 3240 WASHINGTON RD
Address2: SUIRE 200
City: MCMURRAY
State: PA
PostalCode: 153173180
CountryCode: US
TelephoneNumber: 7249414434
FaxNumber: 7249414714
Other Information
ProviderEnumerationDate: 02/28/2007
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSL007949PAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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