Provider Demographics
NPI:1063837714
Name:COOKE, JULIANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:
Last Name:COOKE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 WORCESTER ST
Mailing Address - Street 2:KENNEDY DONOVAN CENTER
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1386
Mailing Address - Country:US
Mailing Address - Phone:508-765-0292
Mailing Address - Fax:
Practice Address - Street 1:486 WORCESTER ST
Practice Address - Street 2:KENNEDY DONOVAN CENTER
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1386
Practice Address - Country:US
Practice Address - Phone:508-765-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9160235Z00000X
CT003887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist