Provider Demographics
NPI:1225280282
Name:COBB, LOREEN T (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LOREEN
Middle Name:T
Last Name:COBB
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1337
Mailing Address - Country:US
Mailing Address - Phone:925-406-4815
Mailing Address - Fax:
Practice Address - Street 1:317 SUNSET DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-1337
Practice Address - Country:US
Practice Address - Phone:925-406-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006494-1235Z00000X
CACA 19200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist