Provider Demographics
NPI:1881465532
Name:COBB, KAITLYN MARIE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:DONALD
Mailing Address - State:OR
Mailing Address - Zip Code:97020-0664
Mailing Address - Country:US
Mailing Address - Phone:503-737-9281
Mailing Address - Fax:
Practice Address - Street 1:2640 PORTLAND RD NE # 120
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0125
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker