Provider Demographics
NPI:1770922312
Name:THOMPSON-COOKE, TAMMY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:THOMPSON-COOKE
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 1:18 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3078
Mailing Address - Country:US
Mailing Address - Phone:415-244-7070
Mailing Address - Fax:
Practice Address - Street 1:18 1ST AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3078
Practice Address - Country:US
Practice Address - Phone:415-244-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011249235Z00000X
CASP11537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist