MEDICARE: WANAKEE COOK

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	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1063142917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANAKEE COOK

Provider Business Mailing Address
First Line	:	2640 WOODWAY AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2154
Country	:	US
Telephone Number	:	202-520-1046
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 WOODWAY AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2154
Country	:	US
Telephone Number	:	202-520-1046
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	05/24/2026

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Directions to “ WANAKEE COOK ” Practice Location

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