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NPI Code Detail

MEDICARE: ERYN COCHRAN MGBOLU M.S. CCC-SLP

MEDICARE: ERYN COCHRAN MGBOLU M.S. CCC-SLP
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1578208690
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERYN COCHRAN MGBOLU M.S. CCC-SLP
Provider Business Mailing Address
First Line : 14051 BEACH BLVD APT 2109
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32250-1798
Country : US
Telephone Number : 706-897-9605
Fax Number :
Provider Business Practice Location Address
First Line : 104 ASHOURIAN AVE STE 105
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32092-5106
Country : US
Telephone Number : 904-230-7761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2022
Last Update Date : 05/08/2024

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Directions to “ ERYN COCHRAN MGBOLU M.S. CCC-SLP” Practice Location

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