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NPI Code Detail

MEDICARE: MS. COURTNEY COOKE LCSW

MEDICARE: MS. COURTNEY COOKE LCSW
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
11041C0700XClinical Social Worker149014230IL

General Provider Information

NPI Number : 1326567751
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COURTNEY COOKE LCSW
Provider Business Mailing Address
First Line : 1201 S PRAIRIE AVE APT 5104
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3570
Country : US
Telephone Number : 248-420-0162
Fax Number :
Provider Business Practice Location Address
First Line : 800 W OAKTON ST
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-4602
Country : US
Telephone Number : 248-420-0162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2017
Last Update Date : 09/18/2017

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