Provider Demographics
NPI:1063957892
Name:COOK, JENNY (MT-BC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 W ROSCOE ST
Mailing Address - Street 2:APT 2N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4322
Mailing Address - Country:US
Mailing Address - Phone:231-301-0407
Mailing Address - Fax:
Practice Address - Street 1:4819 W ROSCOE ST
Practice Address - Street 2:APT 2N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4322
Practice Address - Country:US
Practice Address - Phone:231-301-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC20043386896225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist