Provider Demographics
NPI:1538425871
Name:COOK, CHRISTINA (SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774B ROUTE 197
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-1228
Mailing Address - Country:US
Mailing Address - Phone:860-367-3371
Mailing Address - Fax:
Practice Address - Street 1:1774B ROUTE 197
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-1228
Practice Address - Country:US
Practice Address - Phone:860-367-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist