Provider Demographics
NPI:1477593226
Name:COOK, PEGGY (PH D)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 SAWMILL ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-459-4490
Mailing Address - Fax:614-457-3656
Practice Address - Street 1:4624 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2247
Practice Address - Country:US
Practice Address - Phone:614-459-4490
Practice Address - Fax:614-457-3656
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5519103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP22304Medicare ID - Type Unspecified