Provider Demographics
NPI:1437445582
Name:COSENTINO, GINA M (MS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:COSENTINO
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 1:19100 CRESCENT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7510
Mailing Address - Country:US
Mailing Address - Phone:708-478-5400
Mailing Address - Fax:708-478-5300
Practice Address - Street 1:19100 CRESCENT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7510
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:708-478-5300
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist