1215003298 NPI number — JEANETTE COBB ACSW,LSCSW

Table of content: JEANETTE COBB ACSW,LSCSW (NPI 1215003298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215003298 NPI number — JEANETTE COBB ACSW,LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COBB
Provider First Name:
JEANETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACSW,LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215003298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4770 N BELLEVIEW AVE
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64116-2188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-338-0400
Provider Business Mailing Address Fax Number:
816-459-7885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4770 N BELLEVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-2188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-338-0400
Provider Business Practice Location Address Fax Number:
816-459-7885
Provider Enumeration Date:
11/28/2006

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: 1041C0700X , with the licence number:  MO SW 000430 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27179029 . This is a "BC&BS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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