Provider Demographics
NPI:1043640592
Name:COSTLOW, ALEXANDRA DEANNE (AUD)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:DEANNE
Last Name:COSTLOW
Suffix:
Gender:F
Credentials:AUD
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Mailing Address - Street 1:925 CHESTNUT STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4201
Mailing Address - Country:US
Mailing Address - Phone:215-955-6760
Mailing Address - Fax:215-503-3736
Practice Address - Street 1:925 CHESTNUT STREET
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4201
Practice Address - Country:US
Practice Address - Phone:215-955-6760
Practice Address - Fax:215-503-3736
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAAT006318237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA337775Medicare PIN