Individual
ELIZABETH GRACE COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, BIS, CS
Contact information
Practice address
1519 ALDER AVE, LEWISTON, ID 83501-5815
(208) 503-9104
Mailing address
1519 ALDER AVE, LEWISTON, ID 83501-5815
(208) 503-9104
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222Q00000X
—
ID
Enumeration date
02/10/2023
Last updated
02/10/2023
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