Provider Demographics
NPI:1689663080
Name:COOK, RUTH E (CCC/A)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:1250 FOREST AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1884
Practice Address - Country:US
Practice Address - Phone:207-797-5753
Practice Address - Fax:207-878-1715
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1052231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME317990099Medicaid
ME027843OtherANTHEM
ME01956403Medicare PIN
ME317990099Medicaid
MEQX8578Medicare PIN
ME01956404Medicare PIN