MEDICARE: KENNETH KOBAK PH.D.

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	103T00000X	Psychologist	2256	WI
2	103TB0200X	Cognitive & Behavioral Psychologist	2256	WI
3	103TC1900X	Counseling Psychologist	2256	WI
4	103TP2701X	Group Psychotherapy Psychologist	2256	WI

General Provider Information

NPI Number	:	1346465382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH KOBAK PH.D.

Provider Business Mailing Address
First Line	:	22 N HARWOOD CIR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53717-1314
Country	:	US
Telephone Number	:	608-833-7126
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 N HARWOOD CIR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53717-1314
Country	:	US
Telephone Number	:	608-833-7126
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	09/11/2025

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