Provider Demographics
NPI:1700245396
Name:COSTELLO, JULIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 HIGHWAY 160 W STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8035
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:336-642-0384
Practice Address - Street 1:1698 HIGHWAY 160 W STE 240
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8035
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12308235Z00000X
235Z00000X
SC5945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1639Medicaid