MEDICARE: MRS. CHERYL ANITA COOK LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I0007366	OH

General Provider Information

NPI Number	:	1023228285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL ANITA COOK LISW

Provider Business Mailing Address
First Line	:	1855 E DUBLIN GRANVILLE RD STE 204
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3516
Country	:	US
Telephone Number	:	614-267-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 MCNAUGHTEN RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1678
Country	:	US
Telephone Number	:	614-267-7003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/24/2022

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