Provider Demographics
NPI:1275630071
Name:COSGROVE, JANET FOSTER
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:FOSTER
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N PENN AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3354
Mailing Address - Country:US
Mailing Address - Phone:620-205-7436
Mailing Address - Fax:620-869-9406
Practice Address - Street 1:201 N PENN AVE STE 407
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3354
Practice Address - Country:US
Practice Address - Phone:620-205-7436
Practice Address - Fax:620-869-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106101YM0800X
KS103103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200437260AMedicaid