MEDICARE: MRS. CECELIA COOPER M.ED. 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	SA 5116	FL

General Provider Information

NPI Number	:	1407228729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CECELIA COOPER M.ED. CCC-SLP

Provider Business Mailing Address
First Line	:	2821 E COMMERCIAL BLVD STE 202
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-804-0298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 E COMMERCIAL BLVD STE 202
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4216
Country	:	US
Telephone Number	:	954-804-0298
Fax Number	:

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

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	08/24/2020

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Directions to “ MRS. CECELIA COOPER M.ED. CCC-SLP” Practice Location

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