Individual
KIRBY COSCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
193 SAM LISENBY RD, OZARK, AL 36360-3048
(334) 445-6336
Mailing address
193 SAM LISENBY RD, OZARK, AL 36360-3048
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
TRICARE
—
Enumeration date
07/17/2018
Last updated
07/17/2018
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