Provider Demographics
NPI:1760852040
Name:COOKE, KATHLEEN J (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:COOKE
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CHERRY RIDGE ST
Mailing Address - Street 2:SUITE C-323
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4823
Mailing Address - Country:US
Mailing Address - Phone:210-349-1415
Mailing Address - Fax:210-349-1417
Practice Address - Street 1:3201 CHERRY RIDGE ST
Practice Address - Street 2:SUITE C-323
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-349-1415
Practice Address - Fax:210-349-1417
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist