Provider Demographics
NPI:1053612218
Name:KOPIN, MARIE A (CCC/SLP)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:KOPIN
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 1:1111 ELM
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1431
Mailing Address - Country:US
Mailing Address - Phone:989-772-9453
Mailing Address - Fax:
Practice Address - Street 1:1111 ELM ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1431
Practice Address - Country:US
Practice Address - Phone:989-772-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist