Provider Demographics
NPI:1649993858
Name:COOK, RYLIE ELIZABETH (LSW)
Entity type:Individual
Prefix:
First Name:RYLIE
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 ROLLINDALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-1441
Mailing Address - Country:US
Mailing Address - Phone:260-210-5221
Mailing Address - Fax:
Practice Address - Street 1:347 W BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2299
Practice Address - Country:US
Practice Address - Phone:260-483-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99112637A104100000X
IN33011121A104100000X
IN34011648A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker