Provider Demographics
NPI:1558633644
Name:COOK, LORI ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
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 1:4110 SERENE DR
Mailing Address - Street 2:
Mailing Address - City:BAUXITE
Mailing Address - State:AR
Mailing Address - Zip Code:72011-9185
Mailing Address - Country:US
Mailing Address - Phone:501-681-7677
Mailing Address - Fax:
Practice Address - Street 1:4110 SERENE DR
Practice Address - Street 2:
Practice Address - City:BAUXITE
Practice Address - State:AR
Practice Address - Zip Code:72011-9185
Practice Address - Country:US
Practice Address - Phone:501-681-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist