Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Willow Vivian Copulos

Individual provider Speech-Language Pathologist · NPI 1679458657

Willow Vivian Copulos is a Qualified Speech Language Pathologist in Staten Island, New York. Qualified in 2022, 4 years ago. Licensed in New York.

Years since qualifying
4
Licensed in
NY
In the registry since
2025

Practice location Address checks out

1415 Richmond Ave
Staten Island, NY 10314-1553
Phone: (877) 407-3422
Fax: (877) 407-4329
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 033852 (NY)

Record details

NPI number1679458657
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 8, 2025
Last updated in NPPESAugust 8, 2025
Certification dateAugust 8, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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