Basic Information
| Provider Information | |||||||||
| NPI: | 1104248442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COBB | ||||||||
| FirstName: | KRISTIN | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 RUDOLPH CT | ||||||||
| Address2: | |||||||||
| City: | COHOES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120471507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182585330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6 RUDOLPH CT | ||||||||
| Address2: | |||||||||
| City: | COHOES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120471507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182585330 | ||||||||
| FaxNumber: | 5182745438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2014 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 235Z00000X | 024410 | NY | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 024410-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1104248442 | 05 | NY | MEDICAID |