Healthcare Provider Details

I. General information

NPI: 1689305591
Provider Name (Legal Business Name): MEAGAN DANE'E COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 AERO DR STE E
SAN DIEGO CA
92123-2231
US

IV. Provider business mailing address

87 IH 10 N STE 225
BEAUMONT TX
77707-2549
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-2277
  • Fax: 818-357-2505
Mailing address:
  • Phone: 409-835-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number119755
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number37259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: