Basic Information
| Provider Information | |||||||||
| NPI: | 1942955273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13171 SHUTTER | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493319608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168255873 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 790 FULLER AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495031918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163363909 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6851114287 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.