Provider Demographics
NPI:1073142865
Name:COCHRAN, DOMINIQUE L
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:L
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E 8TH ST APT 223
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-8105
Mailing Address - Country:US
Mailing Address - Phone:623-810-4535
Mailing Address - Fax:
Practice Address - Street 1:1701 E 8TH ST APT 223
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-8105
Practice Address - Country:US
Practice Address - Phone:623-810-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA122982355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant