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Individual

JASON T. COOK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSY.D., HSPP

Contact information

Practice address
7230 ENGLE RD, STE 304, FORT WAYNE, IN 46804-2209
(260) 483-2400
(260) 960-9361
Mailing address
7230 ENGLE RD, STE 304, FORT WAYNE, IN 46804-2209
(260) 481-2700
(260) 481-2717

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041587A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200290630
IN
Enumeration date
02/13/2006
Last updated
10/02/2019
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