Provider Demographics
NPI:1548721871
Name:COOKE THERAPY PLLC
Entity type:Organization
Organization Name:COOKE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DNP, PMHNP-BC
Authorized Official - Phone:503-847-5473
Mailing Address - Street 1:1125 SE MADISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3600
Mailing Address - Country:US
Mailing Address - Phone:503-847-5473
Mailing Address - Fax:503-925-5232
Practice Address - Street 1:1125 SE MADISON ST STE 102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3600
Practice Address - Country:US
Practice Address - Phone:503-847-5473
Practice Address - Fax:503-925-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500748734Medicaid