Healthcare Provider Details

I. General information

NPI: 1568502532
Provider Name (Legal Business Name): PAULA K COOPER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. PAULA K BENHAM

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MILWAUKEE AVE
BURLINGTON WI
53105-1228
US

IV. Provider business mailing address

345 MILWAUKEE AVE
BURLINGTON WI
53105-1228
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-9191
  • Fax: 262-763-7767
Mailing address:
  • Phone: 262-763-9191
  • Fax: 262-763-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1859453
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number867-058
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: