Healthcare Provider Details

I. General information

NPI: 1194655688
Provider Name (Legal Business Name): STEPHANIE LYNN COGBILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PROSPECTOR CT
FOLSOM CA
95630-5119
US

IV. Provider business mailing address

130 PROSPECTOR CT
FOLSOM CA
95630-5119
US

V. Phone/Fax

Practice location:
  • Phone: 916-293-9667
  • Fax: 916-293-9667
Mailing address:
  • Phone: 916-293-9667
  • Fax: 916-293-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: