Basic Information
| Provider Information | |||||||||
| NPI: | 1649820622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | APSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 365 | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541550365 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2640 W POINT RD | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543041344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204903790 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2019 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 131057121 | WI | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 131057-121 | WI | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 131057121 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.