Provider Demographics
NPI:1952583791
Name:COOKE, DANIEL EVAN (MSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EVAN
Last Name:COOKE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HOVEY ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-6230
Mailing Address - Country:US
Mailing Address - Phone:616-260-3440
Mailing Address - Fax:
Practice Address - Street 1:1959 THORNAPPLE RIVER DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-9706
Practice Address - Country:US
Practice Address - Phone:616-259-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085061104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802085061OtherSOCIAL WORKER LICENSE