Provider Demographics
NPI:1437658481
Name:COSTANZO, ROSE (MA CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:MA CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E SHORE RD APT 415
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2446
Mailing Address - Country:US
Mailing Address - Phone:516-426-8524
Mailing Address - Fax:
Practice Address - Street 1:240 E SHORE RD APT 415
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2446
Practice Address - Country:US
Practice Address - Phone:516-426-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist