MEDICARE: LINDA LATRICIA COBBS LPC-IT, SAC

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
1	101YP2500X	Professional Counselor	7294	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15647-131	WI

General Provider Information

NPI Number	:	1164823852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LATRICIA COBBS LPC-IT, SAC

Provider Business Mailing Address
First Line	:	4906 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2325
Country	:	US
Telephone Number	:	414-270-4629
Fax Number	:	414-312-6116

Provider Business Practice Location Address
First Line	:	4906 W FOND DU LAC AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2325
Country	:	US
Telephone Number	:	414-270-4629
Fax Number	:	414-312-6116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	02/21/2025

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