Individual
BENJAMIN COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2651 W WASHINGTON BLVD, CHICAGO, IL 60612-2055
(773) 553-1800
Mailing address
2651 W WASHINGTON BLVD, CHICAGO, IL 60612-2055
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1913659
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1913659
ILLINOIS STATE BOARD OF EDUCATION
IL
Enumeration date
10/31/2017
Last updated
10/31/2017
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