Provider Demographics
NPI:1093932139
Name:COOKE, JUDITH WYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:WYNN
Last Name:COOKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 STABLE DR
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9234
Mailing Address - Country:US
Mailing Address - Phone:610-913-1444
Mailing Address - Fax:610-454-0416
Practice Address - Street 1:555 2ND AVE
Practice Address - Street 2:204D
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3600
Practice Address - Country:US
Practice Address - Phone:610-454-1177
Practice Address - Fax:610-454-0416
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001477L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist