Provider Demographics
NPI:1225267438
Name:COSTANZA, LORI (MA,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:COSTANZA
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PECHINS MILL RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3222
Mailing Address - Country:US
Mailing Address - Phone:484-680-8305
Mailing Address - Fax:
Practice Address - Street 1:80 PECHINS MILL RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3222
Practice Address - Country:US
Practice Address - Phone:484-680-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist