Healthcare Provider Details

I. General information

NPI: 1568074748
Provider Name (Legal Business Name): MEGHAN NOELLE KOBUS CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W BUTLER RD
GREENVILLE SC
29607-4833
US

IV. Provider business mailing address

219 GERALD DR
SIMPSONVILLE SC
29681-4111
US

V. Phone/Fax

Practice location:
  • Phone: 864-757-9918
  • Fax: 864-757-9921
Mailing address:
  • Phone: 864-757-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7294
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: