Provider Demographics
NPI:1417768243
Name:COOKE, GRACE C
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:COOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4541 E 104TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1533
Mailing Address - Country:US
Mailing Address - Phone:440-547-0246
Mailing Address - Fax:
Practice Address - Street 1:4541 E 104TH ST APT 1
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1533
Practice Address - Country:US
Practice Address - Phone:440-547-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSJ471837347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle