MEDICARE: CHRISTINE COOK M.A., CCC/SLP

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	O1-0001101	DE
2	235Z00000X	Speech-Language Pathologist	30001876	NC

General Provider Information

NPI Number	:	1639543770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE COOK M.A., CCC/SLP

Provider Business Mailing Address
First Line	:	1327 FAIRMONT ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-5017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 FAIRMONT ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-5017
Country	:	US
Telephone Number	:	302-753-2946
Fax Number	:

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

Provider Enumeration Date	:	11/29/2015
Last Update Date	:	12/26/2025

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Directions to “ CHRISTINE COOK M.A., CCC/SLP” Practice Location

Language	Start Address	Practice Location

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