MEDICARE: JEANETTE COBB ACSW,LSCSW

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	1041C0700X	Clinical Social Worker	MO SW 000430	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27179029	OTHER	MO	BC&BS

General Provider Information

NPI Number	:	1215003298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE COBB ACSW,LSCSW

Provider Business Mailing Address
First Line	:	4770 N BELLEVIEW AVE
Second Line	:	SUITE 207
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-2188
Country	:	US
Telephone Number	:	913-338-0400
Fax Number	:	816-459-7885

Provider Business Practice Location Address
First Line	:	4770 N BELLEVIEW AVE
Second Line	:	SUITE 207
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-2188
Country	:	US
Telephone Number	:	913-338-0400
Fax Number	:	816-459-7885

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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