Provider Demographics
NPI:1164647590
Name:COPPER, KATHRYN YOUNG (SLP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:YOUNG
Last Name:COPPER
Suffix:
Gender:F
Credentials: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 1692
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1692
Mailing Address - Country:US
Mailing Address - Phone:404-249-8860
Mailing Address - Fax:404-881-6854
Practice Address - Street 1:807 NORTH AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4332
Practice Address - Country:US
Practice Address - Phone:404-248-8860
Practice Address - Fax:404-881-6854
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist