Individual
MS. BONITA MAY COOKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
838 GRANT ST., BELOIT, WI 53511
(608) 322-2393
Mailing address
2240 PRAIRE AVE., 10, BELOIT, WI 53511
(608) 361-7200
(608) 361-7201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16946
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
WI
Enumeration date
10/02/2017
Last updated
10/02/2017
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