Healthcare Provider Details

I. General information

NPI: 1134644297
Provider Name (Legal Business Name): ANNETTE MARIE KOSMAC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6696 GOSHEN RD
GOSHEN OH
45122-9273
US

IV. Provider business mailing address

516 DAKOTA RUN
MAINEVILLE OH
45039-8277
US

V. Phone/Fax

Practice location:
  • Phone: 513-837-2586
  • Fax:
Mailing address:
  • Phone: 937-524-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: