MEDICARE: DAVID COOK LSCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	05936	KS

General Provider Information

NPI Number	:	1205451499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID COOK LSCSW

Provider Business Mailing Address
First Line	:	630 HUMBOLDT ST
Second Line	:	STE 110
City	:	MANHATTAN
State	:	KS
Zip	:	66502-6095
Country	:	US
Telephone Number	:	785-799-5666
Fax Number	:	785-396-4399

Provider Business Practice Location Address
First Line	:	630 HUMBOLDT ST
Second Line	:	STE 110
City	:	MANHATTAN
State	:	KS
Zip	:	66502-6095
Country	:	US
Telephone Number	:	785-799-5666
Fax Number	:	785-396-4399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	02/12/2025

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