Provider Demographics
NPI:1609023464
Name:COOK, HEIDI (MS CCC-LSLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MS CCC-LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4618
Mailing Address - Country:US
Mailing Address - Phone:518-577-4881
Mailing Address - Fax:
Practice Address - Street 1:17 JORDAN LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4618
Practice Address - Country:US
Practice Address - Phone:518-577-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008323-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist