Provider Demographics
NPI:1467475350
Name:COOK, DAMARIS F (AUD CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:DAMARIS
Middle Name:F
Last Name:COOK
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:MS
Other - First Name:DAMARIS
Other - Middle Name:E
Other - Last Name:FOREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD CCC-A
Mailing Address - Street 1:1700 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024
Mailing Address - Country:US
Mailing Address - Phone:731-287-4500
Mailing Address - Fax:731-287-4804
Practice Address - Street 1:1700 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-287-4500
Practice Address - Fax:731-287-4804
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1449231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39671861Medicare PIN