Provider Demographics
NPI:1497980858
Name:COOK, HOLLY M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:M
Last Name:COOK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 DEL PASO RD
Mailing Address - Street 2:SUITE 156
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-7724
Mailing Address - Country:US
Mailing Address - Phone:916-575-8800
Mailing Address - Fax:916-575-8822
Practice Address - Street 1:1972 DEL PASO RD
Practice Address - Street 2:SUITE 156
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-7724
Practice Address - Country:US
Practice Address - Phone:916-575-8800
Practice Address - Fax:916-575-8822
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 12812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist