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General NPI Number Information
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NPI Number | 1013061704
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Entity Type | Individual
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Provider Name | MOLLY KAY COOPER M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 300 N KENTUCKY AVE
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City | ROSWELL
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State | NM
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Zip | 88201-4636
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Country | US
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Telephone | 505-637-3550
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Fax | 505-627-2544
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Provider Business Mailing Address
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Address Line | 2803 N ORCHARD AVE
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City | ROSWELL
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State | NM
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Zip | 88201-7747
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Country | US
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Telephone | 505-625-9791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2463
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License Number State | NM
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