MEDICARE: QUINESSA COOK PHARR MA, CCC-SLP

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

General Provider Information

NPI Number	:	1841446069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINESSA COOK PHARR MA, CCC-SLP

Provider Business Mailing Address
First Line	:	203 EMANUEL CREEK DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3422
Country	:	US
Telephone Number	:	803-614-0314
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 WOODCROSS DR
Second Line	:	APT 224
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2355
Country	:	US
Telephone Number	:	803-614-0314
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	03/13/2020

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