MEDICARE: MARY COPELAND M.C.D, CF-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	9417	LA

General Provider Information

NPI Number	:	1346027091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY COPELAND M.C.D, CF-SLP

Provider Business Mailing Address
First Line	:	2076 METHODIST CAMP LOOP
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-7696
Country	:	US
Telephone Number	:	662-910-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 HIGHWAY 160
Second Line	:
City	:	COTTON VALLEY
State	:	LA
Zip	:	71018-3164
Country	:	US
Telephone Number	:	318-832-4716
Fax Number	:

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

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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