Provider Demographics
NPI:1104158658
Name:BECKY COSNER, SPEECH-LANGUAGE SERVICE
Entity type:Organization
Organization Name:BECKY COSNER, SPEECH-LANGUAGE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:330-605-9042
Mailing Address - Street 1:11110 FARGO RD NW
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-8934
Mailing Address - Country:US
Mailing Address - Phone:330-605-9042
Mailing Address - Fax:
Practice Address - Street 1:11110 FARGO RD NW
Practice Address - Street 2:
Practice Address - City:MINERAL CITY
Practice Address - State:OH
Practice Address - Zip Code:44656-8934
Practice Address - Country:US
Practice Address - Phone:330-605-9042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 9198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty