Provider Demographics
NPI:1558704684
Name:COOK, STEPHANIE WELDON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WELDON
Last Name:COOK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WAGNER FARM RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1567
Mailing Address - Country:US
Mailing Address - Phone:207-939-6433
Mailing Address - Fax:
Practice Address - Street 1:1003 RIVER RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5305
Practice Address - Country:US
Practice Address - Phone:207-939-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist