Provider Demographics
NPI:1316070444
Name:COOKE, JULIA CLODIUS (MHS CCC SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:CLODIUS
Last Name:COOKE
Suffix:
Gender:F
Credentials:MHS 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:PO BOX A
Mailing Address - Street 2:106 W FOURTH ST
Mailing Address - City:DIXON
Mailing Address - State:MO
Mailing Address - Zip Code:65459-0166
Mailing Address - Country:US
Mailing Address - Phone:573-759-7163
Mailing Address - Fax:573-759-2506
Practice Address - Street 1:106 W FOURTH ST
Practice Address - Street 2:BOX A
Practice Address - City:DIXON
Practice Address - State:MO
Practice Address - Zip Code:65459-0166
Practice Address - Country:US
Practice Address - Phone:573-759-7163
Practice Address - Fax:573-759-2506
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467589909Medicaid