Provider Demographics
NPI:1740356765
Name:COSGROVE, JANETTE LOUISE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:LOUISE
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:JANETTE
Other - Middle Name:LOUISE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 NORTH LONGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4134
Mailing Address - Country:US
Mailing Address - Phone:815-962-5585
Mailing Address - Fax:815-962-8945
Practice Address - Street 1:210 N LONGWOOD ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4134
Practice Address - Country:US
Practice Address - Phone:815-962-5585
Practice Address - Fax:815-962-8945
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95486Medicare ID - Type Unspecified