Provider Demographics
NPI:1265685671
Name:COSSABOON, EMILY JEANNINE (AUD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JEANNINE
Last Name:COSSABOON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 ROSEBAY LN APT 404
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3818
Mailing Address - Country:US
Mailing Address - Phone:410-530-1060
Mailing Address - Fax:
Practice Address - Street 1:9420 KEY WEST AVE STE 310
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-315-5888
Practice Address - Fax:301-315-5866
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE02-0000169231H00000X
MD00991231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist