Provider Demographics
NPI:1598149858
Name:COSGROVE, LEANNA (MS, SLP)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 DESTINY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2993
Mailing Address - Country:US
Mailing Address - Phone:916-415-0119
Mailing Address - Fax:916-415-0120
Practice Address - Street 1:6960 DESTINY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2993
Practice Address - Country:US
Practice Address - Phone:916-415-0119
Practice Address - Fax:916-415-0120
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist