Provider Demographics
NPI:1689972358
Name:COOK THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:COOK THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACKBURN-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:606-497-7533
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:MOUSIE
Mailing Address - State:KY
Mailing Address - Zip Code:41839-0212
Mailing Address - Country:US
Mailing Address - Phone:606-497-7533
Mailing Address - Fax:606-785-5441
Practice Address - Street 1:2970 POSSUM TROT RD # 2
Practice Address - Street 2:
Practice Address - City:LEBURN
Practice Address - State:KY
Practice Address - Zip Code:41831-8950
Practice Address - Country:US
Practice Address - Phone:606-497-7533
Practice Address - Fax:606-785-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3571252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK044131Medicare PIN