Provider Demographics
NPI:1649348848
Name:COOK, ANNISCHA E (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:ANNISCHA
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 VERA CRUZ AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1210
Mailing Address - Country:US
Mailing Address - Phone:763-536-9013
Mailing Address - Fax:763-536-9013
Practice Address - Street 1:4213 VERA CRUZ AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1210
Practice Address - Country:US
Practice Address - Phone:763-536-9013
Practice Address - Fax:763-536-9013
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN090681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN151040OtherUCARE PROVIDER ID
MN17F10COOtherBLUE CROSS-BLUE SHIELD ID
MN62-75573OtherMEDICA
MN990991033373OtherPREFERRED ONE
MN17F09COOtherBLUE CROSS-BLUE SHIELD ID
MN00135511OtherMETROPOLITAN HEALTH PLAN