MEDICARE: KACEY L COPELAND

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	2202012194	VA

General Provider Information

NPI Number	:	1578397741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACEY L COPELAND

Provider Business Mailing Address
First Line	:	516 WINTERWATER CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3571
Country	:	US
Telephone Number	:	757-636-0966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 KRISTINA WAY
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-8917
Country	:	US
Telephone Number	:	757-547-0153
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	11/18/2025

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Directions to “ KACEY L COPELAND ” Practice Location

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