Jacey Lynn Cook, LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301013688 Issued in MI

Practice address

605 E 7TH Ave
Suite 9
Sault Sainte Marie, MI 49783-3111

Phone

(906) 635-7270

Fax

(906) 635-7688

NPI assigned

Nov 23, 2007

Last updated

Nov 23, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Old Town Psychological ServicesGroup PAC ID 2466600101, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Old Town Psychological Services

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1093989162
  Medicare reassignment Care Compare group NPD
• Old Town Psychological Services-Gaylord

  • Clinical Child & Adolescent Psychologist
  • Gaylord, MI
  • NPI 1750659249
  NPD (past)
• Weber and Devers Psychological Services, P.C.

  • Psychologist
  • Sault Sainte Marie, MI
  • NPI 1861609505
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195776000000",
    "number": "1629259361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 E 7TH AVE",
            "address_2": "SUITE 9",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833111",
            "telephone_number": "906-635-7270",
            "fax_number": "906-635-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E 7TH AVE",
            "address_2": "SUITE 9",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833111",
            "telephone_number": "906-635-7270",
            "fax_number": "906-635-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "JACEY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-23",
        "last_updated": "2007-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Cockerill
• Anesa Antoinette Collier
• Allissa Collins
• Katheryn Conley, M.A. CCC-SLP
• Emily Marie Conner, PA-C
• Lara C Cook
• Goldie Lynn Cooper, LMSW,QMHP,QIDP,CMHP
• Kevin Patrick Cooper, D.D.S.
• Pamela Elizabeth Cooper, RDH
• Janessa K Copenhafer, PT, DPT, WCC

• Clinical Psychologist in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.