1720659386 NPI number — ZACHARY KOPP CCC-SLP

Table of content: ZACHARY KOPP CCC-SLP (NPI 1720659386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720659386 NPI number — ZACHARY KOPP CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPP
Provider First Name:
ZACHARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720659386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 PIEDMONT AVE NE UNIT 3023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30308-6209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-612-8015
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 ARROWHEAD BLVD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-742-0446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  77315 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77315 . This is a "COMMONWEALTH OF MASSACHUSETTS BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 14275454 . This is a "AMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32219 . This is a "SPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY AND HEARING AID DISPENSERS BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SLP011526 . This is a "STATE BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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