Healthcare Provider Details

I. General information

NPI: 1750218806
Provider Name (Legal Business Name): JESSICA MARA COPPERMAN M.A., CCC-SLP, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 U ST NW
WASHINGTON DC
20009-7522
US

IV. Provider business mailing address

1380 BRYANT ST NE APT 204
WASHINGTON DC
20018-1185
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-1537
  • Fax:
Mailing address:
  • Phone: 718-938-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP000897
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: