Provider Demographics
NPI:1962629733
Name:COOK, BRENDA M (MA-CCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:COOK
Suffix:
Gender:F
Credentials:MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3982 STATE ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-3757
Mailing Address - Country:US
Mailing Address - Phone:518-753-3277
Mailing Address - Fax:518-594-0355
Practice Address - Street 1:3982 STATE ROUTE 11
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-3757
Practice Address - Country:US
Practice Address - Phone:518-753-3277
Practice Address - Fax:518-594-0355
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000973-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter