Provider Demographics
NPI:1235498239
Name:COOK, JESSICA D (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:COOK
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 1:8931 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6806
Mailing Address - Country:US
Mailing Address - Phone:303-704-0233
Mailing Address - Fax:
Practice Address - Street 1:13659 E 104TH AVE UNIT 800
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9406
Practice Address - Country:US
Practice Address - Phone:720-520-7755
Practice Address - Fax:719-212-1473
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12345Medicaid