Basic Information
| Provider Information | |||||||||
| NPI: | 1265152755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 107 IDO AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443012010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302564959 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1293 COPLEY RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443202766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303741199 | ||||||||
| FaxNumber: | 3303740151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2022 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.