Provider Demographics
NPI:1093285637
Name:COBBLESTONE MIDWIFERY
Entity Type:Organization
Organization Name:COBBLESTONE MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPM
Authorized Official - Phone:206-261-2312
Mailing Address - Street 1:5617 ASHLEY SQUARE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:206-261-2312
Mailing Address - Fax:
Practice Address - Street 1:5617 ASHLEY SQUARE SOUTH
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:206-261-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty