Provider Demographics
NPI:1609329432
Name:COOK, COURTNEY M (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:COOK
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E WASHINGTON AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3489
Mailing Address - Country:US
Mailing Address - Phone:217-821-3511
Mailing Address - Fax:
Practice Address - Street 1:406 E WASHINGTON AVE APT 9
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3489
Practice Address - Country:US
Practice Address - Phone:217-821-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS