Individual
LAUREN LYNNE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
135 RUTLEDGE AVE, CHARLESTON, SC 29425-8903
(843) 792-8299
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
4153
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023231479
—
SC
05
—
1851541221
—
SC
Enumeration date
07/10/2020
Last updated
11/25/2020
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