Provider Demographics
NPI:1760628630
Name:COOK, LISA M (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-1252
Mailing Address - Country:US
Mailing Address - Phone:765-649-8161
Mailing Address - Fax:765-641-8350
Practice Address - Street 1:10731 N STATE ROAD 13
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-8874
Practice Address - Country:US
Practice Address - Phone:765-552-5009
Practice Address - Fax:765-552-8347
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker