Provider Demographics
NPI:1053690834
Name:COOPER, ANDREA S (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:S
Last Name:COOPER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8729
Mailing Address - Country:US
Mailing Address - Phone:732-580-8624
Mailing Address - Fax:
Practice Address - Street 1:19 PORTCHESTER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4396
Practice Address - Country:US
Practice Address - Phone:732-580-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS000832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist