Provider Demographics
NPI:1811106446
Name:COSTIGAN, JUDY (MSPA)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 51ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7708
Mailing Address - Country:US
Mailing Address - Phone:206-527-3314
Mailing Address - Fax:
Practice Address - Street 1:6050 51ST AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7708
Practice Address - Country:US
Practice Address - Phone:206-527-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist