Provider Demographics
NPI:1215003298
Name:COBB, JEANETTE (ACSW,LSCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:ACSW,LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 N BELLEVIEW AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2188
Mailing Address - Country:US
Mailing Address - Phone:913-338-0400
Mailing Address - Fax:816-459-7885
Practice Address - Street 1:4770 N BELLEVIEW AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-2188
Practice Address - Country:US
Practice Address - Phone:913-338-0400
Practice Address - Fax:816-459-7885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO SW 0004301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27179029OtherBC&BS
MO532281Medicare UPIN
MO0009701AMedicare ID - Type Unspecified