Provider Demographics
NPI:1831475821
Name:COOK, JULIANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 FOREST PARK CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2205
Mailing Address - Country:US
Mailing Address - Phone:619-616-6138
Mailing Address - Fax:
Practice Address - Street 1:1226 W SOUTH JORDAN PKWY
Practice Address - Street 2:BUILDING A
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5518
Practice Address - Country:US
Practice Address - Phone:619-616-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8002250-35011041C0700X
TX354841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical