Provider Demographics
NPI:1114793999
Name:COOK, NATALIE GAIL (EDD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:GAIL
Last Name:COOK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65717-9168
Mailing Address - Country:US
Mailing Address - Phone:417-746-1420
Mailing Address - Fax:417-746-1428
Practice Address - Street 1:528 W NORWOOD ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MO
Practice Address - Zip Code:65717-9168
Practice Address - Country:US
Practice Address - Phone:417-746-1420
Practice Address - Fax:417-746-1428
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332981103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO332981OtherSCHOOL PSYCHOLOGIST