Healthcare Provider Details

I. General information

NPI: 1811715519
Provider Name (Legal Business Name): JESSICA J COOKE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE 3N-14
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL STE 3N-14
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6069
  • Fax:
Mailing address:
  • Phone: 314-454-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2024040405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: