MEDICARE: LYNN COOK SR

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	103TA0700X	Adult Development & Aging Psychologist	23615422	MO

General Provider Information

NPI Number	:	1194581082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN COOK SR

Provider Business Mailing Address
First Line	:	9412 MYRTLE AVE APT 179
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-3852
Country	:	US
Telephone Number	:	816-986-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	9412 MYRTLE AVE APT 179
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-3852
Country	:	US
Telephone Number	:	816-986-7556
Fax Number	:

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

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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Directions to “ LYNN COOK SR ” Practice Location

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