Provider Demographics
NPI:1356167951
Name:COBB, KELSEY MAY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MAY
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MAY
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:522 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2245
Mailing Address - Country:US
Mailing Address - Phone:308-440-2267
Mailing Address - Fax:
Practice Address - Street 1:522 TILDEN ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2245
Practice Address - Country:US
Practice Address - Phone:308-440-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician