Healthcare Provider Details

I. General information

NPI: 1033029095
Provider Name (Legal Business Name): LAUREN KOBES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14379 US-9W
RAVENA NY
12161
US

IV. Provider business mailing address

PO BOX 61
SOUTH BETHLEHEM NY
12161-0061
US

V. Phone/Fax

Practice location:
  • Phone: 518-756-3124
  • Fax:
Mailing address:
  • Phone: 518-756-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: