Provider Demographics
NPI:1396034690
Name:COOGAN, ANNE BEESLEY (MS)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BEESLEY
Last Name:COOGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PARK DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1839
Mailing Address - Country:US
Mailing Address - Phone:323-243-6810
Mailing Address - Fax:323-664-4630
Practice Address - Street 1:1901 PARK DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1839
Practice Address - Country:US
Practice Address - Phone:323-243-6810
Practice Address - Fax:323-664-4630
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist