Provider Demographics
NPI:1861250771
Name:DA COSTA, STEPHANIE M (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:M
Last Name:DA COSTA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CENTRAL AVE APT 121B
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5601
Mailing Address - Country:US
Mailing Address - Phone:973-432-1802
Mailing Address - Fax:
Practice Address - Street 1:15 MICROLAB RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1623
Practice Address - Country:US
Practice Address - Phone:973-992-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01140500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist