Provider Demographics
NPI:1619125473
Name:COPE, DONNA DANNETTE (MED,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:DANNETTE
Last Name:COPE
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:DANNETTE
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:RR 2 BOX 1155
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9641
Mailing Address - Country:US
Mailing Address - Phone:918-696-1529
Mailing Address - Fax:
Practice Address - Street 1:1607 S MUSKOGEE AVE STE B
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5440
Practice Address - Country:US
Practice Address - Phone:918-696-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2176235Z00000X
OK3065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3065Medicaid
AR2176Medicaid