Provider Demographics
NPI:1396802799
Name:KOBLE, MARYLYN D (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:MARYLYN
Middle Name:D
Last Name:KOBLE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 MATLOCK RD
Mailing Address - Street 2:STE 303
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2922
Mailing Address - Country:US
Mailing Address - Phone:817-472-7720
Mailing Address - Fax:817-417-7280
Practice Address - Street 1:3132 MATLOCK RD STE 303
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2922
Practice Address - Country:US
Practice Address - Phone:817-472-7720
Practice Address - Fax:817-417-7280
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51286231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073575080OtherORGANIZATION NPI
TX1073575080OtherORGANIZATION NPI