Provider Demographics
NPI:1932637659
Name:COOK, ALICIA MICHELLE (SLPA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELLE
Last Name:COOK
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41113 W RIO BRAVO DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-9538
Mailing Address - Country:US
Mailing Address - Phone:928-640-2545
Mailing Address - Fax:
Practice Address - Street 1:41113 W RIO BRAVO DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-9538
Practice Address - Country:US
Practice Address - Phone:928-640-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA105862355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant