Provider Demographics
NPI:1689110678
Name:COOK, JENNA LYNN (CDPT)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 EVERGREEN PARK DR SW APT 402
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6057
Mailing Address - Country:US
Mailing Address - Phone:360-870-9238
Mailing Address - Fax:
Practice Address - Street 1:2708 WESTMOOR CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5754
Practice Address - Country:US
Practice Address - Phone:360-943-8810
Practice Address - Fax:360-943-0931
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60429386101YM0800X
WACO60709275101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health