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General NPI Number Information
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NPI Number | 1649348848
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Entity Type | Individual
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Provider Name | ANNISCHA E COOK LICSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4213 VERA CRUZ AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1210
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Country | US
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Telephone | 763-536-9013
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Fax | 763-536-9013
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Provider Business Mailing Address
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Address Line | 4213 VERA CRUZ AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1210
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Country | US
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Telephone | 763-536-9013
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Fax | 763-536-9013
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09068
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License Number State | MN
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