Provider Demographics
NPI:1447317003
Name:COBB, JUDITH ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:COBB
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOOD PARKDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97041-8714
Mailing Address - Country:US
Mailing Address - Phone:541-806-0236
Mailing Address - Fax:
Practice Address - Street 1:1942 12TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9542
Practice Address - Country:US
Practice Address - Phone:541-806-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist