MEDICARE: DEANNA M. COSCHIGNANO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2769	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2769	OTHER	CO	PSYCHOLOGY LICENSE
2	1156	OTHER	HI	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1831121318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA M. COSCHIGNANO PH.D.

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-357-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIRCLE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-1411
Country	:	US
Telephone Number	:	719-526-5371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/25/2011

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