Provider Demographics
NPI:1174307201
Name:COSSLETT, HARRIET ELIZABETH
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:ELIZABETH
Last Name:COSSLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:COSSLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1477 W LAKE ST UNIT 225
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5111
Mailing Address - Country:US
Mailing Address - Phone:612-516-8750
Mailing Address - Fax:
Practice Address - Street 1:1801 AMERICAN BLVD E
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1232
Practice Address - Country:US
Practice Address - Phone:612-677-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician