Provider Demographics
NPI:1720341134
Name:COOK, AMANDA K (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:COOK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 LEXINGTON AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-7058
Mailing Address - Country:US
Mailing Address - Phone:651-317-3723
Mailing Address - Fax:651-482-9119
Practice Address - Street 1:3499 LEXINGTON AVE N STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-7058
Practice Address - Country:US
Practice Address - Phone:651-317-3723
Practice Address - Fax:651-482-9119
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist