Provider Demographics
NPI:1386011286
Name:COOK, ANNA (PLMSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0647
Mailing Address - Country:US
Mailing Address - Phone:501-982-0528
Mailing Address - Fax:501-533-6378
Practice Address - Street 1:2411 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4211
Practice Address - Country:US
Practice Address - Phone:501-982-0528
Practice Address - Fax:501-533-6378
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker