Provider Demographics
NPI:1720560279
Name:COOK, ASHLEY L (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SCIENCE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1064
Mailing Address - Country:US
Mailing Address - Phone:608-236-4460
Mailing Address - Fax:608-236-4461
Practice Address - Street 1:4513 VERNON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4964
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:608-236-4461
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WI7930125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist