Doctor Name: | BETHANY COOK |
NPI Number: | 1215258454 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | 071.008237 |
Business Practice Address: | 3903 Indianapolis Blvd East Chicago, IN - 463122555 |
Business Phone Number: | 2193926001 |
Business Fax Number: | |
Mailing Address: | 246 E Janata Blvd, LOMBARD |
State: | IL |
Postal Code: | 601485317 |
Phone Number: | 6304248900 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2010 |
NPI Last Update Date: | 01/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.008237 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |