Provider Demographics
NPI:1255843892
Name:COSTLOW, ALEXANDRIA WILBURN
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:WILBURN
Last Name:COSTLOW
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 1:7050 W 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1810
Mailing Address - Country:US
Mailing Address - Phone:913-802-2227
Mailing Address - Fax:913-273-0235
Practice Address - Street 1:7050 W 107TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1810
Practice Address - Country:US
Practice Address - Phone:913-802-2227
Practice Address - Fax:913-273-0235
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI90-0747294OtherCHITTER CHATTER