Healthcare Provider Details

I. General information

NPI: 1962606723
Provider Name (Legal Business Name): ELSIE MARIE COOK CMHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEENIE COOK

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 W FOND DU LAC AVE
MILWAUKEE WI
53216-2324
US

IV. Provider business mailing address

570 W FIEBRANTZ AVE
MILWAUKEE WI
53212-1047
US

V. Phone/Fax

Practice location:
  • Phone: 414-871-6122
  • Fax: 414-871-2552
Mailing address:
  • Phone: 414-332-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: