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NPI Code Detail

MEDICARE: MRS. KELLY IRENE KOPROVIC M.S. CCC-SLP

MEDICARE: MRS. KELLY IRENE KOPROVIC M.S. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP1270AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659589687
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY IRENE KOPROVIC M.S. CCC-SLP
Provider Business Mailing Address
First Line : 2208 LEE CREEK DR
Second Line :
City : VAN BUREN
State : AR
Zip : 72956-6911
Country : US
Telephone Number : 479-806-7440
Fax Number :
Provider Business Practice Location Address
First Line : 2208 LEE CREEK DR
Second Line :
City : VAN BUREN
State : AR
Zip : 72956-6911
Country : US
Telephone Number : 479-806-7440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 10/03/2018

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Directions to “ MRS. KELLY IRENE KOPROVIC M.S. CCC-SLP” Practice Location

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