Basic Information
| Provider Information | |||||||||
| NPI: | 1598149858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSGROVE | ||||||||
| FirstName: | LEANNA | ||||||||
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| Credential: | MS, SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6960 DESTINY DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164150119 | ||||||||
| FaxNumber: | 9164150120 | ||||||||
| Practice Location | |||||||||
| Address1: | 6960 DESTINY DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164150119 | ||||||||
| FaxNumber: | 9164150120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22420 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.