Provider Demographics
NPI:1285487199
Name:COOK, DOLORES Y (CHW)
Entity type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:Y
Last Name:COOK
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-8770
Mailing Address - Country:US
Mailing Address - Phone:828-465-9816
Mailing Address - Fax:
Practice Address - Street 1:532 SE 9TH AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-8770
Practice Address - Country:US
Practice Address - Phone:828-465-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110609172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker