Provider Demographics
NPI:1497314447
Name:COOK, RASHONNA
Entity Type:Individual
Prefix:
First Name:RASHONNA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 W HEARN RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4719
Mailing Address - Country:US
Mailing Address - Phone:216-801-9709
Mailing Address - Fax:
Practice Address - Street 1:10460 N 92ND ST STE 206
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4547
Practice Address - Country:US
Practice Address - Phone:480-882-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17194104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMSW-17194OtherSTATE OF ARIZONA BOARD OF BEHAVIORAL EXAMINERS