Provider Demographics
NPI:1528468147
Name:COOK, ANNETTE MICHELLE (CNA LEVEL 1 MED AIDE)
Entity type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:MICHELLE
Last Name:COOK
Suffix:
Gender:F
Credentials:CNA LEVEL 1 MED AIDE
Other - Prefix:MISS
Other - First Name:MICHELL
Other - Middle Name:ANETTE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4218 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-1806
Mailing Address - Country:US
Mailing Address - Phone:314-534-6624
Mailing Address - Fax:314-535-4394
Practice Address - Street 1:4218 NORTH GRAND BLVD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107
Practice Address - Country:US
Practice Address - Phone:314-534-6624
Practice Address - Fax:314-535-4394
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health