Healthcare Provider Details

I. General information

NPI: 1699668756
Provider Name (Legal Business Name): SOPHIA ADELE COBIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOMINION DR STE A
HUDSON WI
54016-9333
US

IV. Provider business mailing address

901 DOMINION DR STE A
HUDSON WI
54016-9333
US

V. Phone/Fax

Practice location:
  • Phone: 715-808-8070
  • Fax: 715-808-8009
Mailing address:
  • Phone: 715-808-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1215-228
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: