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General NPI Number Information
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NPI Number | 1497379432
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Entity Type | Individual
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Provider Name | MRS. VANESSA COOK
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Gender | Female
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 09/07/2020
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Provider Practice Location Address
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Address Line | 1646 LINDEN PARK LN
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City | AURORA
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State | IL
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Zip | 60504-4806
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Country | US
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Telephone | 773-217-4907
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Fax |
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Provider Business Mailing Address
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Address Line | 725 KELLEY DR
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City | NORTH AURORA
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State | IL
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Zip | 60542-4003
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Country | US
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Telephone | 773-217-4907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-43829
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License Number State |
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