Healthcare Provider Details

I. General information

NPI: 1720560279
Provider Name (Legal Business Name): ASHLEY L COOK MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 VERNON BLVD STE 100
MADISON WI
53705-4964
US

IV. Provider business mailing address

440 SCIENCE DR STE 300
MADISON WI
53711-1064
US

V. Phone/Fax

Practice location:
  • Phone: 608-236-4460
  • Fax: 608-236-4461
Mailing address:
  • Phone: 608-236-4460
  • Fax: 608-236-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7930125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: