Provider Demographics
NPI:1588695324
Name:KOSKO, SHIRLEY A (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:A
Last Name:KOSKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2921
Mailing Address - Country:US
Mailing Address - Phone:847-816-8172
Mailing Address - Fax:847-367-9895
Practice Address - Street 1:611 ROCKLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2000
Practice Address - Country:US
Practice Address - Phone:847-816-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical