Provider Demographics
NPI:1154820108
Name:COBB, KALEN NICOLE
Entity Type:Individual
Prefix:
First Name:KALEN
Middle Name:NICOLE
Last Name:COBB
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 1:5955 N WINTHROP AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3535
Mailing Address - Country:US
Mailing Address - Phone:857-399-2315
Mailing Address - Fax:
Practice Address - Street 1:1550 S INDIANA AVE STE 2E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2857
Practice Address - Country:US
Practice Address - Phone:773-377-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker