Individual
JESSICA COOKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS. ED, BCBA
Contact information
Practice address
350 LANSING DR, MANTUA, NJ 08051
(925) 594-1704
Mailing address
350 LANSING DR, MANTUA, NJ 08051-1200
(925) 594-1704
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-15295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12667951
CAQH
—
01
—
14-15-295
BACB
—
Enumeration date
03/20/2014
Last updated
05/16/2018
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