Individual
MR. CARL RICHARD COSLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4656 W JEFFERSON BLVD, STE 285, FORT WAYNE, IN 46804
(260) 422-9372
(260) 422-0843
Mailing address
4656 W JEFFERSON BLVD, STE 285, FORT WAYNE, IN 46804
(260) 422-9372
(260) 422-0843
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000209A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000143216
ANTHEM
IN
01
—
075209000
MAGELLAN
IN
05
—
200806690A
—
IN
01
—
280482
VALUE OPTIONS
IN
01
—
4405313
AETNA
IN
Enumeration date
07/02/2006
Last updated
12/02/2008
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