Individual
KAYLA COSGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
325 6TH AVE, SOUTH CHARLESTON, WV 25303-1231
(304) 720-3383
Mailing address
325 6TH AVE, SOUTH CHARLESTON, WV 25303-1231
(304) 720-3383
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB674412
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F585990
BACB
WV
Enumeration date
09/08/2021
Last updated
09/08/2021
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