Provider Demographics
NPI:1497187983
Name:COOK, LEAH VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:VICTORIA
Last Name:COOK
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 1:12001 N COUNTY ROAD 300 E
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:IN
Mailing Address - Zip Code:47338-9511
Mailing Address - Country:US
Mailing Address - Phone:765-760-3297
Mailing Address - Fax:
Practice Address - Street 1:12001 N COUNTY ROAD 300 E
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:IN
Practice Address - Zip Code:47338-9511
Practice Address - Country:US
Practice Address - Phone:765-760-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist