Provider Demographics
NPI:1962606723
Name:COOK, ELSIE MARIE (CMHT)
Entity type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:CMHT
Other - Prefix:
Other - First Name:TEENIE
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:570 W FIEBRANTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1047
Mailing Address - Country:US
Mailing Address - Phone:414-332-0697
Mailing Address - Fax:
Practice Address - Street 1:4929 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2324
Practice Address - Country:US
Practice Address - Phone:414-871-6122
Practice Address - Fax:414-871-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide