Healthcare Provider Details

I. General information

NPI: 1457690208
Provider Name (Legal Business Name): SANDRA K COOK-LASS LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 COURTHOUSE DR
CHARLOTTE MI
48813-1054
US

IV. Provider business mailing address

812 E JOLLY RD SUITE 210
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-5100
  • Fax:
Mailing address:
  • Phone: 517-346-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802085318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: