Provider Demographics
NPI:1902341845
Name:HANISCH, COBY REBECCA
Entity Type:Individual
Prefix:
First Name:COBY
Middle Name:REBECCA
Last Name:HANISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 PARRISH ST APT E
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1200
Mailing Address - Country:US
Mailing Address - Phone:541-222-9543
Mailing Address - Fax:
Practice Address - Street 1:2821 PARRISH ST APT E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1200
Practice Address - Country:US
Practice Address - Phone:541-222-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist