Healthcare Provider Details

I. General information

NPI: 1609895143
Provider Name (Legal Business Name): GARY D COPELAND SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 IRON HORSE TRL
HARVEST AL
35749-8130
US

IV. Provider business mailing address

126 IRON HORSE TRL
HARVEST AL
35749-8130
US

V. Phone/Fax

Practice location:
  • Phone: 256-508-1125
  • Fax:
Mailing address:
  • Phone: 256-508-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1826
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: