Individual
MR. JACOB TANNER COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, CCC-SLP
Contact information
Practice address
140 KIMBERLY DR, MOUNT AIRY, NC 27030-9604
(336) 648-0007
Mailing address
140 KIMBERLY DR, MOUNT AIRY, NC 27030-9604
(336) 648-0007
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14061396
NC
235Z00000X
Speech-Language Pathologist
9885
NC
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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