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NPI Code Detail

MEDICARE: MANDY COBB

MEDICARE: MANDY COBB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst2024022024MO
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1114624053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY COBB
Provider Business Mailing Address
First Line : 7777 BONHOMME AVE STE 1800
Second Line :
City : CLAYTON
State : MO
Zip : 63105-1931
Country : US
Telephone Number : 636-202-0693
Fax Number : 855-568-2494
Provider Business Practice Location Address
First Line : 11432 TESSON FERRY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-6925
Country : US
Telephone Number : 217-525-8332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2023
Last Update Date : 06/18/2024

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Directions to “ MANDY COBB ” Practice Location

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