Provider Demographics
NPI:1659632768
Name:COOK, AUDREY EVA
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:EVA
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 1:1225 S GEAR AVE
Mailing Address - Street 2:MERCY PLAZA, SUITE 251
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-768-3700
Mailing Address - Fax:319-768-3712
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:MERCY PLAZA, SUITE 251
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-768-3700
Practice Address - Fax:319-768-3712
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health