Provider Demographics
NPI:1457479727
Name:COBB, MARY F (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
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 1:1426 HARBOUR BLUE ST
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-8073
Mailing Address - Country:US
Mailing Address - Phone:813-394-7787
Mailing Address - Fax:
Practice Address - Street 1:1426 HARBOUR BLUE ST
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-8073
Practice Address - Country:US
Practice Address - Phone:813-394-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist