Provider Demographics
NPI:1275144966
Name:COBB, ANN KATHERINE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:KATHERINE
Last Name:COBB
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 56TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6651
Mailing Address - Country:US
Mailing Address - Phone:309-738-1280
Mailing Address - Fax:
Practice Address - Street 1:3513 56TH STREET PL
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6651
Practice Address - Country:US
Practice Address - Phone:309-738-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist