Provider Demographics
NPI:1205366390
Name:MCCOOK, CYNTHIA FALLON
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:FALLON
Last Name:MCCOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7380
Mailing Address - Country:US
Mailing Address - Phone:214-773-4913
Mailing Address - Fax:
Practice Address - Street 1:1824 COMMONS CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist