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General NPI Number Information
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NPI Number | 1568687218
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Entity Type | Individual
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Provider Name | ELIZABETH THERESE COOK PHD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 804 OFFICERS ROW
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City | VANCOUVER
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State | WA
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Zip | 98661-3846
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Country | US
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Telephone | 360-241-6318
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Fax | 360-574-8627
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Provider Business Mailing Address
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Address Line | 804 OFFICERS ROW
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City | VANCOUVER
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State | WA
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Zip | 98661-3846
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Country | US
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Telephone | 360-241-6318
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Fax | 360-574-8627
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY2507
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License Number State | WA
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