Provider Demographics
NPI:1649399205
Name:COOPERMAN, EDYE GORDON (SLP/CCC MED)
Entity type:Individual
Prefix:MRS
First Name:EDYE
Middle Name:GORDON
Last Name:COOPERMAN
Suffix:
Gender:F
Credentials:SLP/CCC MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-6418
Mailing Address - Country:US
Mailing Address - Phone:215-882-2286
Mailing Address - Fax:215-361-8555
Practice Address - Street 1:101 PIONEER DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-6418
Practice Address - Country:US
Practice Address - Phone:215-882-2286
Practice Address - Fax:215-882-2286
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001066L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist