Crystal Cook – Social Worker in Taylor, MI

Key facts

NPI: 1205299237
Entity type: Individual (NPI type 1)
Primary specialty: Social Worker 104100000X
Practice address: 20300 Superior Rd
Taylor, MI 48180-6331
Phone: (734) 785-7700
NPI assigned: Mar 29, 2016
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
6801098399	MI	MD	Clinical Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	6801098399	MI
Social Worker	104100000X			Yes

Addresses

Primary practice location

20300 Superior Rd
Taylor, MI 48180-6331

Mailing address

5065 Gateshead St
Grosse Pointe Farms, MI 48236-2170

Other identifiers

Identifier	Type	State	Issuer
1205299237	Medicaid	MI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2022.

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1205299237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5065 GATESHEAD ST",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482362170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20300 SUPERIOR RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481806331",
            "telephone_number": "734-785-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "CRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-29",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801098399",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205299237",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylor, MI

All providers in Taylor, MI · Social Worker in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.