Basic Information
| Provider Information | |||||||||
| NPI: | 1437674579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 PENNSYLVANIA AVE E APT E | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163652792 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | REHABWORKS AT WARREN GENERAL HOSPITAL | ||||||||
| Address2: | TWO CRESCENT PARK WEST | ||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147264070 | ||||||||
| FaxNumber: | 8147230416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.