Provider Demographics
NPI:1679385025
Name:KOBZA, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KOBZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LARK DR APT 6
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1639
Mailing Address - Country:US
Mailing Address - Phone:317-695-2597
Mailing Address - Fax:
Practice Address - Street 1:16414 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8396
Practice Address - Country:US
Practice Address - Phone:317-584-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician