Provider Demographics
NPI:1265179857
Name:COOK, JENNIFER WILSON (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILSON
Last Name:COOK
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 19TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4832
Mailing Address - Country:US
Mailing Address - Phone:806-219-0418
Mailing Address - Fax:
Practice Address - Street 1:1628 19TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4832
Practice Address - Country:US
Practice Address - Phone:806-219-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist