Individual
TRACY COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1253 GAUSETOWN RD, KINGSTREE, SC 29556-7491
(843) 382-7641
Mailing address
1681 BLAKELY RD, SALTERS, SC 29590-3437
(843) 687-6641
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
3039
SC
Other
Enumeration date
08/09/2017
Last updated
08/09/2017
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