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NPI Code Detail

MEDICARE: KAYLEE COBB

MEDICARE: KAYLEE COBB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21041C0700XClinical Social WorkerS.2512776OH
3172V00000XCommunity Health Worker
4101YP2500XProfessional CounselorASW135485CA

General Provider Information

NPI Number : 1417640731
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLEE COBB
Provider Business Mailing Address
First Line : 3870 MURPHY CANYON RD STE 320
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-4453
Country : US
Telephone Number : 858-300-0460
Fax Number :
Provider Business Practice Location Address
First Line : 11156 CANAL RD STE A
Second Line :
City : CINCINNATI
State : OH
Zip : 45241-5816
Country : US
Telephone Number : 513-772-6166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2023
Last Update Date : 01/12/2026

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Directions to “ KAYLEE COBB ” Practice Location

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