Provider Demographics
NPI:1679940514
Name:COSGROVE, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 1ST ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5236
Mailing Address - Country:US
Mailing Address - Phone:608-244-4066
Mailing Address - Fax:
Practice Address - Street 1:111 S 1ST ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5236
Practice Address - Country:US
Practice Address - Phone:608-244-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI275-228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health