MEDICARE: ELIZABETH COENEN COOPER M.A., CCC-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	2202004656	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	194110	OTHER	VA	ANTHEM BCBS
2	201511442	OTHER	VA	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2157798	OTHER	VA	MAMSI
5	201511442	OTHER	VA	TRICARE

General Provider Information

NPI Number	:	1316943616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH COENEN COOPER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	335 BAHIA LN
Second Line	:
City	:	CAPE CARTERET
State	:	NC
Zip	:	28584-9356
Country	:	US
Telephone Number	:	703-217-3511
Fax Number	:	252-764-2436

Provider Business Practice Location Address
First Line	:	17028 LEJEUNE ROAD
Second Line	:
City	:	QUANTICO
State	:	VA
Zip	:	22134-1757
Country	:	US
Telephone Number	:	703-217-3511
Fax Number	:	703-221-6905

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/24/2008

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Directions to “ ELIZABETH COENEN COOPER M.A., CCC-SLP” Practice Location

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