Individual
SHASTA TOBI COOKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
677 1/2 W 12TH AVE, EUGENE, OR 97402
(530) 356-0655
Mailing address
677 HALF W 12TH AVE, EUGENE, OR 97402
(530) 356-0655
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y3753896
GOV
CA
Enumeration date
05/15/2018
Last updated
05/15/2018
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