1649348848 NPI number — ANNISCHA E COOK LICSW, MSW

Table of content: ANNISCHA E COOK LICSW, MSW (NPI 1649348848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649348848 NPI number — ANNISCHA E COOK LICSW, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
ANNISCHA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649348848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4213 VERA CRUZ AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROBBINSDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-536-9013
Provider Business Mailing Address Fax Number:
763-536-9013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4213 VERA CRUZ AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBBINSDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-536-9013
Provider Business Practice Location Address Fax Number:
763-536-9013
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  09068 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151040 . This is a "UCARE PROVIDER ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 17F10CO . This is a "BLUE CROSS-BLUE SHIELD ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-75573 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 990991033373 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 17F09CO . This is a "BLUE CROSS-BLUE SHIELD ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 00135511 . This is a "METROPOLITAN HEALTH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com