Provider Demographics
NPI:1518483965
Name:COOK, ALICIA JANE (AA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JANE
Last Name:COOK
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 COUNTY ROAD 44 APT 2
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-9462
Mailing Address - Country:US
Mailing Address - Phone:567-674-0657
Mailing Address - Fax:
Practice Address - Street 1:775 E ELIZA ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1486
Practice Address - Country:US
Practice Address - Phone:419-679-1219
Practice Address - Fax:419-679-1219
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator