MEDICARE: MAYLIN BRIANNA 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	235Z00000X	Speech-Language Pathologist	41YS01358600	NJ

General Provider Information

NPI Number	:	1417812991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYLIN BRIANNA COOK

Provider Business Mailing Address
First Line	:	1 BETHANY RD STE 15
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1659
Country	:	US
Telephone Number	:	614-931-0321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BETHANY RD STE 15
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1659
Country	:	US
Telephone Number	:	614-931-0321
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ MAYLIN BRIANNA COOK ” Practice Location

Language	Start Address	Practice Location

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