Provider Demographics
NPI:1831329499
Name:COCHRAN, JOHN EDGAR (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDGAR
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-9298
Mailing Address - Country:US
Mailing Address - Phone:505-787-4520
Mailing Address - Fax:
Practice Address - Street 1:1490 3RD AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-9298
Practice Address - Country:US
Practice Address - Phone:505-787-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist