Provider Demographics
NPI:1972547016
Name:COSTA, LAURA M (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:COSTA
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1416
Mailing Address - Country:US
Mailing Address - Phone:419-534-3111
Mailing Address - Fax:419-534-3113
Practice Address - Street 1:3450 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1416
Practice Address - Country:US
Practice Address - Phone:419-534-3111
Practice Address - Fax:419-534-3113
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02302231H00000X
MI12009261237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M76300Medicare ID - Type UnspecifiedIND PROV ID NUMBER