MEDICARE: MRS. JENNIFER ELAINE COOPER MSCCCA

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	231H00000X	Audiologist	118465	MO
2	237600000X	Audiologist-Hearing Aid Fitter	1947	KS
3	237600000X	Audiologist-Hearing Aid Fitter	118465	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22494034	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1528040227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ELAINE COOPER MSCCCA

Provider Business Mailing Address
First Line	:	2101 LIBERTY DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-7720
Country	:	US
Telephone Number	:	816-415-3233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 NE DOUGLAS ST STE 101
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-4704
Country	:	US
Telephone Number	:	816-415-3233
Fax Number	:	816-415-3234

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/26/2025

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