MEDICARE: JENNY COOK MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	C20043386896	IL

General Provider Information

NPI Number	:	1063957892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY COOK MT-BC

Provider Business Mailing Address
First Line	:	4819 W ROSCOE ST
Second Line	:	APT 2N
City	:	CHICAGO
State	:	IL
Zip	:	60641-4322
Country	:	US
Telephone Number	:	231-301-0407
Fax Number	:

Provider Business Practice Location Address
First Line	:	4819 W ROSCOE ST
Second Line	:	APT 2N
City	:	CHICAGO
State	:	IL
Zip	:	60641-4322
Country	:	US
Telephone Number	:	231-301-0407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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