MEDICARE: ASHLEIGH COOK

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	251S00000X	Community/Behavioral Health Agency
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1093159162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEIGH COOK

Provider Business Mailing Address
First Line	:	7039 MESQUITE ST.
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	909-894-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	7039 MESQUITE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	909-894-8607
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS ASHLEIGH DIANE COOK
Credential	:
Telephone Number	:	909-894-8607

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/23/2013

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Directions to “ASHLEIGH COOK ” Practice Location

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