Provider Demographics
NPI:1801362058
Name:COSTIGAN, SAMANTHA JO (MSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W BOONE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2560
Mailing Address - Country:US
Mailing Address - Phone:509-328-3802
Mailing Address - Fax:
Practice Address - Street 1:720 W BOONE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2560
Practice Address - Country:US
Practice Address - Phone:509-328-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health