Healthcare Provider Details

I. General information

NPI: 1962048785
Provider Name (Legal Business Name): AMBER COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3 MILE RD NW
GRAND RAPIDS MI
49544-1685
US

IV. Provider business mailing address

8865 100TH ST SE
ALTO MI
49302-9221
US

V. Phone/Fax

Practice location:
  • Phone: 616-469-3870
  • Fax:
Mailing address:
  • Phone: 616-377-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number7402000265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: