Provider Demographics
NPI:1386219582
Name:COBLEIGH, SAVANAH CHEYANNE
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:CHEYANNE
Last Name:COBLEIGH
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 1:2400 SCIENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2560
Mailing Address - Country:US
Mailing Address - Phone:517-374-8066
Mailing Address - Fax:
Practice Address - Street 1:2770 CARPENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-4104
Practice Address - Country:US
Practice Address - Phone:734-585-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC142758115704106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician