MEDICARE: CONSTANCE COOPER

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	109462	TX

General Provider Information

NPI Number	:	1659724862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE COOPER

Provider Business Mailing Address
First Line	:	5940 FOREST PARK RD
Second Line	:	#3043
City	:	DALLAS
State	:	TX
Zip	:	75235-6415
Country	:	US
Telephone Number	:	903-539-3629
Fax Number	:

Provider Business Practice Location Address
First Line	:	5940 FOREST PARK RD
Second Line	:	#3043
City	:	DALLAS
State	:	TX
Zip	:	75235-6415
Country	:	US
Telephone Number	:	903-539-3629
Fax Number	:

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

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	07/22/2016

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Directions to “ CONSTANCE COOPER ” Practice Location

Language	Start Address	Practice Location

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