Provider Demographics
NPI:1124428123
Name:COOL, AIMEE
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:COOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2442
Mailing Address - Country:US
Mailing Address - Phone:440-593-7264
Mailing Address - Fax:440-593-6556
Practice Address - Street 1:400 MILL ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2442
Practice Address - Country:US
Practice Address - Phone:440-593-7264
Practice Address - Fax:440-593-6556
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1512514103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool