Provider Demographics
NPI:1720088990
Name:COOK, JO ANN L (EDD)
Entity Type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4916
Mailing Address - Country:US
Mailing Address - Phone:407-740-5259
Mailing Address - Fax:407-628-3933
Practice Address - Street 1:1316 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4916
Practice Address - Country:US
Practice Address - Phone:407-740-5259
Practice Address - Fax:407-628-3933
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS308103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1529OtherBCBS NONPARTICIPATING #