Provider Demographics
NPI:1659699676
Name:COSTELLO, STEPHANIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:430 NE 160TH AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5496
Mailing Address - Country:US
Mailing Address - Phone:509-768-7311
Mailing Address - Fax:
Practice Address - Street 1:430 NE 160TH AVE APT 29
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5496
Practice Address - Country:US
Practice Address - Phone:509-768-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health