Healthcare Provider Details

I. General information

NPI: 1013709369
Provider Name (Legal Business Name): JOSHUA COOK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E 200 N
LOGAN UT
84321-4034
US

IV. Provider business mailing address

90 E 200 N
LOGAN UT
84321-4034
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-0750
  • Fax:
Mailing address:
  • Phone: 435-752-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: