Provider Demographics
NPI:1568576361
Name:COOK, SARA RUTH (CCC A)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RUTH
Last Name:COOK
Suffix:
Gender:F
Credentials:CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20611 CEDAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352
Mailing Address - Country:US
Mailing Address - Phone:952-492-5893
Mailing Address - Fax:
Practice Address - Street 1:1800 2ND STREET NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:612-789-1236
Practice Address - Fax:612-706-5555
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist