Healthcare Provider Details

I. General information

NPI: 1457276362
Provider Name (Legal Business Name): MADELYN COSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 NORFOLK ST
GLEN ALLEN VA
23060-2381
US

IV. Provider business mailing address

22455 SCOJO DR
FRANKLIN VA
23851-2822
US

V. Phone/Fax

Practice location:
  • Phone: 804-261-5095
  • Fax:
Mailing address:
  • Phone: 757-376-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: