Provider Demographics
NPI:1508107046
Name:COOK, JERILYN SM
Entity Type:Individual
Prefix:MS
First Name:JERILYN
Middle Name:SM
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 1:3-3204 KUHIO HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1135
Mailing Address - Country:US
Mailing Address - Phone:808-821-6954
Mailing Address - Fax:808-821-6958
Practice Address - Street 1:3-3204 KUHIO HWY STE 104
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1135
Practice Address - Country:US
Practice Address - Phone:808-821-6954
Practice Address - Fax:808-821-6958
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker