Healthcare Provider Details

I. General information

NPI: 1831221381
Provider Name (Legal Business Name): KIMBERLY KOBUS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM KOBUS PH.D.

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E BENSON BLVD STE 518
ANCHORAGE AK
99503-4019
US

IV. Provider business mailing address

1001 E CHICAGO AVE STE 119
NAPERVILLE IL
60540-5500
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-3988
  • Fax: 630-585-3988
Mailing address:
  • Phone: 630-585-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10242831
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number060-009249
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-006044
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number209075
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: