=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578780540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA GAIL COOK M.S., C.C.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 06/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5935 PREMIER WAY UNIT 1329
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-376-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5935 PREMIER WAY UNIT 1329
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-469-3558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP4661
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------