MEDICARE: ANNETTE COSGROVE

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	235Z00000X	Speech-Language Pathologist	SP6032	OH

General Provider Information

NPI Number	:	1043766504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE COSGROVE

Provider Business Mailing Address
First Line	:	1720 GLENDALE MILFORD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1233
Country	:	US
Telephone Number	:	513-771-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 GLENDALE MILFORD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1233
Country	:	US
Telephone Number	:	513-771-7600
Fax Number	:

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

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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Directions to “ ANNETTE COSGROVE ” Practice Location

Language	Start Address	Practice Location

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