Provider Demographics
NPI:1750892170
Name:COBERT, AMY ZAISER (SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ZAISER
Last Name:COBERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SPRING COVE LN
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3138
Mailing Address - Country:US
Mailing Address - Phone:847-226-8740
Mailing Address - Fax:
Practice Address - Street 1:5974 JARMANS GAP RD
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3340
Practice Address - Country:US
Practice Address - Phone:434-825-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist