Provider Demographics
NPI:1003011222
Name:COOK, WYNNA GAIL (MSCCCSLP)
Entity Type:Individual
Prefix:MS
First Name:WYNNA
Middle Name:GAIL
Last Name:COOK
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6819 NAT ROGERS ROAD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40107
Mailing Address - Country:US
Mailing Address - Phone:502-549-9938
Mailing Address - Fax:
Practice Address - Street 1:120 LIFE CARE WAY
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2059
Practice Address - Country:US
Practice Address - Phone:502-348-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist