Provider Demographics
NPI:1730492554
Name:HOOKE, AUDREY ROSE (RN)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:ROSE
Last Name:HOOKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:ROSE
Other - Last Name:HOOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:12501 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12501 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3243
Practice Address - Country:US
Practice Address - Phone:313-961-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704238338103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst