Provider Demographics
NPI:1568833523
Name:COOK, BRIANNE (BS)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 264
Mailing Address - Street 2:
Mailing Address - City:RIRIE
Mailing Address - State:ID
Mailing Address - Zip Code:83443
Mailing Address - Country:US
Mailing Address - Phone:850-529-6435
Mailing Address - Fax:
Practice Address - Street 1:1740 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-346-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker