Healthcare Provider Details

I. General information

NPI: 1952196768
Provider Name (Legal Business Name): CLAYTON COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 SE QUAKERVALE RD
RIVERTON KS
66770-4185
US

IV. Provider business mailing address

1535 W 15TH ST FL 3
LAWRENCE KS
66045-7608
US

V. Phone/Fax

Practice location:
  • Phone: 620-848-2300
  • Fax:
Mailing address:
  • Phone: 785-864-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14139
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: