Provider Demographics
NPI:1497836027
Name:COSTON, JADE H (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:H
Last Name:COSTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GOLF TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5609
Mailing Address - Country:US
Mailing Address - Phone:850-322-0817
Mailing Address - Fax:
Practice Address - Street 1:2020 GOLF TERRACE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5609
Practice Address - Country:US
Practice Address - Phone:850-322-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist