Healthcare Provider Details

I. General information

NPI: 1225152150
Provider Name (Legal Business Name): ANNE DARCY COOK MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W PETERSON AVE SUITE 301
CHICAGO IL
60646-5713
US

IV. Provider business mailing address

1403 WILDER ST
EVANSTON IL
60202-1182
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-1616
  • Fax: 773-202-1410
Mailing address:
  • Phone: 847-491-6246
  • Fax: 773-202-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: