Healthcare Provider Details

I. General information

NPI: 1528040227
Provider Name (Legal Business Name): JENNIFER ELAINE COOPER MSCCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ELAINE DANN MSCCCA

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 NE DOUGLAS ST STE 101
LEES SUMMIT MO
64086-4704
US

IV. Provider business mailing address

2101 LIBERTY DR
LIBERTY MO
64068-7720
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-3233
  • Fax: 816-415-3234
Mailing address:
  • Phone: 816-415-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number118465
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1947
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number118465
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: