Provider Demographics
NPI:1538174917
Name:MONROE-COOK, DALE GORDON (PHD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:GORDON
Last Name:MONROE-COOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SHERMAN AVE.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4803
Mailing Address - Country:US
Mailing Address - Phone:847-869-1500
Mailing Address - Fax:847-869-1515
Practice Address - Street 1:1560 SHERMAN AVE.
Practice Address - Street 2:SUITE 400
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4803
Practice Address - Country:US
Practice Address - Phone:847-869-1500
Practice Address - Fax:847-869-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001607587OtherBLUE CROSS BLUE SHIELD
IL948052Medicare ID - Type Unspecified