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General NPI Number Information
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NPI Number | 1093372302
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Entity Type | Individual
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Provider Name | ANN R COOK BA, LADC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 7501 80TH ST S STE 108
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4121
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Country | US
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Telephone | 612-564-8073
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Fax | 651-925-0453
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Provider Business Mailing Address
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Address Line | 1636 HEWITT AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-1236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304497
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License Number State | MN
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