Provider Demographics
NPI:1881985745
Name:COOK, JENNIFER A (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5370
Mailing Address - Country:US
Mailing Address - Phone:304-242-7060
Mailing Address - Fax:304-845-3064
Practice Address - Street 1:2606 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5370
Practice Address - Country:US
Practice Address - Phone:304-242-7060
Practice Address - Fax:304-845-3064
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)