MEDICARE: JILL COOKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL009202	PA

General Provider Information

NPI Number	:	1083874994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL COOKE

Provider Business Mailing Address
First Line	:	73 EQUESTRIAN DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-6803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6743 FAIRWAY DR E
Second Line	:
City	:	FAYETTEVILLE
State	:	PA
Zip	:	17222-9400
Country	:	US
Telephone Number	:	717-360-3989
Fax Number	:	717-352-8360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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Directions to “ JILL COOKE ” Practice Location

Language	Start Address	Practice Location

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