Provider Demographics
NPI:1306966411
Name:COOKE, GINA F (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:F
Last Name:COOKE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22448 LA FITTE DR
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4219
Mailing Address - Country:US
Mailing Address - Phone:804-304-1749
Mailing Address - Fax:
Practice Address - Street 1:5220 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4302
Practice Address - Country:US
Practice Address - Phone:305-294-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist