Provider Demographics
NPI:1225222789
Name:COWAN-OBERBECK, CATHERINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:COWAN-OBERBECK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:OBERBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:7777 N WICKHAM RD
Mailing Address - Street 2:STE 21
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7976
Mailing Address - Country:US
Mailing Address - Phone:321-752-4552
Mailing Address - Fax:
Practice Address - Street 1:7777 N WICKHAM RD
Practice Address - Street 2:STE 21
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7976
Practice Address - Country:US
Practice Address - Phone:321-752-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY145231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678741096Medicaid
FL678741096Medicaid