Healthcare Provider Details

I. General information

NPI: 1447354832
Provider Name (Legal Business Name): LIBBY MARIE COOK CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PL
FLINT MI
48503-2465
US

IV. Provider business mailing address

1411 VOLLAR DR
FLINT MI
48532-5323
US

V. Phone/Fax

Practice location:
  • Phone: 810-767-5750
  • Fax: 810-768-7568
Mailing address:
  • Phone: 810-720-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000042
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: