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NPI Code Detail

MEDICARE: B SCOT COOK PSY D CLINICAL PSYCH

MEDICARE: B SCOT COOK PSY D CLINICAL PSYCH
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
1103TC0700XClinical Psychologist1342OR

General Provider Information

NPI Number : 1386719755
Entity Type Code : Individual
Provider Name (Legal Business Name) : B SCOT COOK PSY D CLINICAL PSYCH
Provider Business Mailing Address
First Line : 2250 D ST NE
Second Line :
City : SALEM
State : OR
Zip : 97301-2768
Country : US
Telephone Number : 503-364-6093
Fax Number : 503-364-5121
Provider Business Practice Location Address
First Line : 2250 D ST NE
Second Line :
City : SALEM
State : OR
Zip : 97301-2768
Country : US
Telephone Number : 503-364-6093
Fax Number : 503-364-5121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 03/11/2008

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Practice Location Address:
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1831264217 — ELIZABETH B HAMILTON PHD CLINICAL PSYCH
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