MEDICARE: DR. ALISON M COBB PHD

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	391	MT
2	103TC0700X	Clinical Psychologist	391	MT

General Provider Information

NPI Number	:	1538313762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISON M COBB PHD

Provider Business Mailing Address
First Line	:	121 HICKORY ST
Second Line	:	SUITE 1
City	:	MISSOULA
State	:	MT
Zip	:	59801-1896
Country	:	US
Telephone Number	:	406-546-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 HICKORY ST
Second Line	:	SUITE 1
City	:	MISSOULA
State	:	MT
Zip	:	59801-1896
Country	:	US
Telephone Number	:	406-546-2222
Fax Number	:

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

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	04/12/2011

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