Healthcare Provider Details

I. General information

NPI: 1528248705
Provider Name (Legal Business Name): MR. JOSHUA LAWRENCE COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 SE POWELL BLVD
PORTLAND OR
97202-3371
US

IV. Provider business mailing address

3040 SW 15TH CT
GRESHAM OR
97080-5750
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-9591
  • Fax:
Mailing address:
  • Phone: 503-839-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: