Provider Demographics
NPI:1972611077
Name:COKLEY, ROBERT L (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:COKLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W PRAIRIE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2471
Mailing Address - Country:US
Mailing Address - Phone:217-422-0053
Mailing Address - Fax:217-422-0374
Practice Address - Street 1:348 W PRAIRIE AVE
Practice Address - Street 2:STE 3
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-2471
Practice Address - Country:US
Practice Address - Phone:217-422-0053
Practice Address - Fax:217-422-0374
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL939571Medicare ID - Type Unspecified