Provider Demographics
NPI:1659017796
Name:COOK, JENNIFER LAUREN (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:COOK
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 MARK TWAIN DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-5701
Mailing Address - Country:US
Mailing Address - Phone:614-783-2901
Mailing Address - Fax:
Practice Address - Street 1:3481 MARK TWAIN DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-5701
Practice Address - Country:US
Practice Address - Phone:614-783-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19018841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical