Individual
MR. THOMAS MILES COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
40 CAMELOT DR, FOND DU LAC, WI 54935-8049
(920) 907-8201
Mailing address
1271 DUBLIN DR, HARTFORD, WI 53027-9763
(262) 224-0900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3948-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39223900
—
WI
Enumeration date
12/19/2006
Last updated
07/08/2007
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