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General NPI Number Information
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NPI Number | 1114624053
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Entity Type | Individual
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Provider Name | MANDY COBB
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Gender | Female
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 11432 TESSON FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6925
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Country | US
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Telephone | 217-525-8332
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 BONHOMME AVE STE 1800
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City | CLAYTON
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State | MO
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Zip | 63105-1931
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Country | US
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Telephone | 636-202-0693
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Fax | 855-568-2494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2024022024
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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