Doctor Name: | MRS. AMANDA COSTAGLIOLA |
NPI Number: | 1134597263 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP-CCC |
License Number: | 41YS00758900 |
Business Practice Address: | 11 Windbeam Rd Riverdale, NJ - 074571618 |
Business Phone Number: | 9739036417 |
Business Fax Number: | |
Mailing Address: | 11 Windbeam Rd, RIVERDALE |
State: | NJ |
Postal Code: | 074571618 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/06/2015 |
NPI Last Update Date: | 09/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 41YS00758900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |