Healthcare Provider Details

I. General information

NPI: 1558052191
Provider Name (Legal Business Name): ALLISON LYNNE COSMA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 GRAVOIS RD
HIGH RIDGE MO
63049-2606
US

IV. Provider business mailing address

1610 GRAVOIS RD
HIGH RIDGE MO
63049-2606
US

V. Phone/Fax

Practice location:
  • Phone: 636-534-0228
  • Fax: 636-534-0195
Mailing address:
  • Phone: 636-534-0228
  • Fax: 636-534-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2024048148
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: