Provider Demographics
NPI:1427624626
Name:COOK, WENDY LEE (RT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEE
Last Name:COOK
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 PIER NORTH BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-1361
Mailing Address - Country:US
Mailing Address - Phone:586-405-7944
Mailing Address - Fax:
Practice Address - Street 1:402 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2131
Practice Address - Country:US
Practice Address - Phone:810-845-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44010017112279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health