Kelly Cooper-Bistricky, MS CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP18316 Issued in CA

Practice address

2528 Ocean Ave
San Francisco, CA 94132-1614

Phone

(415) 469-4988

Fax

(646) 758-5802

NPI assigned

Mar 3, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Cooper Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shannon Kong, Ms, CCC

  • Speech-Language Pathologist
  • San Francisco, CA
  • NPI 1720371990
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299110400000",
    "number": "1053619767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 OCEAN AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941321614",
            "telephone_number": "415-469-4988",
            "fax_number": "646-758-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 OCEAN AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941321614",
            "telephone_number": "415-469-4988",
            "fax_number": "646-758-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER-BISTRICKY",
        "first_name": "KELLY",
        "credential": "MS CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-03",
        "last_updated": "2011-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP18316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "COOPER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa R Coomes, M.D.
• Charn Maree Coonan
• C Glenn Cooney, M.D.
• Elisa Cooney
• Jack Cooney
• Michelle Fernandes Cooper-Sood, MSW/ASW
• Amy Beth Cooper, OTR/L
• Barbara Cooper, MSN, FNP-BC
• Carolyn B Cooper, M.S., L.M.F.T.
• Carolyn S Cooper, M.D.

• Speech-Language Pathologist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.