Provider Demographics
NPI:1447304589
Name:COOPER, ALLISON GRIFFIN (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GRIFFIN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-0715
Mailing Address - Country:US
Mailing Address - Phone:352-463-7324
Mailing Address - Fax:
Practice Address - Street 1:3210 SW 56TH TRAIL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-0715
Practice Address - Country:US
Practice Address - Phone:352-463-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist