1316103385 NPI number — CYNTHIA L ANDERSON-DOBROSKI

Table of content: CYNTHIA L ANDERSON-DOBROSKI (NPI 1316103385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316103385 NPI number — CYNTHIA L ANDERSON-DOBROSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON-DOBROSKI
Provider First Name:
CYNTHIA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOBROSKI
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316103385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61201-5351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-3200
Provider Business Mailing Address Fax Number:
309-779-2755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-2031
Provider Business Practice Location Address Fax Number:
309-779-2917
Provider Enumeration Date:
07/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180-003170 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 083827 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)