MEDICARE: MERCEDES K COOPER M.S. C.C.C.- SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP#13858	CA

General Provider Information

NPI Number	:	1053677963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES K COOPER M.S. C.C.C.- SLP

Provider Business Mailing Address
First Line	:	120A SANTA MARGARITA AVE
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-2725
Country	:	US
Telephone Number	:	650-324-0648
Fax Number	:

Provider Business Practice Location Address
First Line	:	120A SANTA MARGARITA AVE
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-2725
Country	:	US
Telephone Number	:	650-324-0648
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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