Individual
HEATHER COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2108 63RD ST, KENOSHA, WI 53143-4454
(262) 652-2406
Mailing address
2108 63RD ST, KENOSHA, WI 53143-4454
(262) 652-2406
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10203-125
WI
101YP2500X
Professional Counselor
4832-226
WI
Other
Enumeration date
12/17/2020
Last updated
01/09/2023
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