Healthcare Provider Details

I. General information

NPI: 1447185160
Provider Name (Legal Business Name): JENNIFER COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIE COOK

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 ESTRELLA DR
LEXINGTON KY
40511-8670
US

IV. Provider business mailing address

636 ESTRELLA DR
LEXINGTON KY
40511-8670
US

V. Phone/Fax

Practice location:
  • Phone: 859-608-0173
  • Fax:
Mailing address:
  • Phone: 859-608-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: