Healthcare Provider Details

I. General information

NPI: 1215847405
Provider Name (Legal Business Name): MADELYN GRACE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN COOK

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

IV. Provider business mailing address

34 CENTRAL AVE
ATHENS OH
45701-1501
US

V. Phone/Fax

Practice location:
  • Phone: 614-227-9444
  • Fax:
Mailing address:
  • Phone: 326-202-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2614538
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: