Provider Demographics
NPI:1336622414
Name:COOK, JENNIFER DAWN (MSW, MHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3534
Mailing Address - Country:US
Mailing Address - Phone:509-892-4342
Mailing Address - Fax:509-891-1081
Practice Address - Street 1:1102 S RAYMOND RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3534
Practice Address - Country:US
Practice Address - Phone:509-892-4342
Practice Address - Fax:509-891-1081
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60384038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker