Individual
VONETTA COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2715 MACKEY PL # PL135, SHREVEPORT, LA 71118-2544
(318) 402-7789
Mailing address
124 PANTHEON LN, SHREVEPORT, LA 71115-4506
(318) 402-7789
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003279654
—
LA
Enumeration date
11/21/2016
Last updated
11/21/2016
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