Healthcare Provider Details

I. General information

NPI: 1710648035
Provider Name (Legal Business Name): MOLLY COOK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY STROH

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WILDCAT DR STE A
MARION IL
62959-1513
US

IV. Provider business mailing address

109 CALIFORNIA ST PO BOX 577
CARTERVILLE IL
62918
US

V. Phone/Fax

Practice location:
  • Phone: 618-969-8228
  • Fax: 618-998-0880
Mailing address:
  • Phone: 618-519-9200
  • Fax: 618-985-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: