Basic Information
| Provider Information | |||||||||
| NPI: | 1790228286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | TONYA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 WALL ST | ||||||||
| Address2: | UNIT 302 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551011449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6129874444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1983 SLOAN PL | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513265700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2016 | ||||||||
| LastUpdateDate: | 12/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 21648 | MN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.