Individual
JACLYN COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2424 JODY RAE ST, NILES, MI 49120-7707
(269) 357-9183
Mailing address
2424 JODY RAE ST, NILES, MI 49120-7707
(269) 357-9183
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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