Basic Information
| Provider Information | |||||||||
| NPI: | 1043640592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSTLOW | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | DEANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 CHESTNUT STREET | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556760 | ||||||||
| FaxNumber: | 2155033736 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 CHESTNUT STREET | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556760 | ||||||||
| FaxNumber: | 2155033736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2013 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | AT006318 | PA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.