Provider Demographics
NPI:1578942199
Name:COOK, JESSICA (BA, CDP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:BA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2241
Mailing Address - Country:US
Mailing Address - Phone:509-444-7033
Mailing Address - Fax:509-444-7038
Practice Address - Street 1:960 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2241
Practice Address - Country:US
Practice Address - Phone:509-444-7033
Practice Address - Fax:509-444-7038
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60557537101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)