Healthcare Provider Details

I. General information

NPI: 1003726993
Provider Name (Legal Business Name): DR. JESSE DAVID COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 RESEARCH PARK BLVD
MADISON WI
53719-1176
US

IV. Provider business mailing address

7350 BLUE MAPLE TRL # 315
MADISON WI
53719-4036
US

V. Phone/Fax

Practice location:
  • Phone: 608-232-3171
  • Fax:
Mailing address:
  • Phone: 602-790-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5358-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: