Individual
JENNA NICOLE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 E RYAN RD, OAK CREEK, WI 53154-4563
(414) 570-3590
Mailing address
9070 S CHICAGO CT, OAK CREEK, WI 53154-4243
(414) 430-2117
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6601-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100279167
—
WI
Enumeration date
05/10/2024
Last updated
11/18/2024
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