Provider Demographics
NPI:1487716171
Name:COOK, JENNIFER KAY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:COOK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:ERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1029 BEARDED OAKS TERRACE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2365
Mailing Address - Country:US
Mailing Address - Phone:407-392-7173
Mailing Address - Fax:
Practice Address - Street 1:1029 BEARDED OAKS TER
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2365
Practice Address - Country:US
Practice Address - Phone:407-392-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005636235Z00000X
FLSA11634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist