Provider Demographics
NPI:1720318496
Name:COSDEN, OLIVIA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:COSDEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 PINE ST
Mailing Address - Street 2:2R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6140
Mailing Address - Country:US
Mailing Address - Phone:609-760-4824
Mailing Address - Fax:
Practice Address - Street 1:918 PINE ST
Practice Address - Street 2:2R
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6140
Practice Address - Country:US
Practice Address - Phone:609-760-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist