Provider Demographics
NPI:1932506458
Name:COOK, PAMELA R (PSYD)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:R
Other - Last Name:VANDER LEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2081 CALISTOGA DR STE 3N
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-4834
Mailing Address - Country:US
Mailing Address - Phone:815-277-9906
Mailing Address - Fax:815-277-9907
Practice Address - Street 1:2081 CALISTOGA DR STE 3N
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4834
Practice Address - Country:US
Practice Address - Phone:815-277-9906
Practice Address - Fax:815-277-9907
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical