Provider Demographics
NPI:1861671752
Name:COOK, JILL MAE (MS CFY SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MAE
Last Name:COOK
Suffix:
Gender:F
Credentials:MS CFY SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 LOST CIR
Mailing Address - Street 2:APT B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-5352
Mailing Address - Country:US
Mailing Address - Phone:270-779-7002
Mailing Address - Fax:270-780-9757
Practice Address - Street 1:590 LOST CIR
Practice Address - Street 2:APT B
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-5352
Practice Address - Country:US
Practice Address - Phone:270-779-7002
Practice Address - Fax:270-780-9757
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-07-009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist