Provider Demographics
NPI:1780162933
Name:COOPER, SHELBY KATE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:KATE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BLUE PRIDE DR
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-1593
Mailing Address - Country:US
Mailing Address - Phone:573-486-3197
Mailing Address - Fax:573-486-3244
Practice Address - Street 1:328 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1216
Practice Address - Country:US
Practice Address - Phone:573-486-3197
Practice Address - Fax:573-486-3244
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist