MEDICARE: MEGAN ELISE COSTO MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	8533	SC
2	235Z00000X	Speech-Language Pathologist	PCET003556	GA

General Provider Information

NPI Number	:	1508505462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELISE COSTO MS, CCC-SLP

Provider Business Mailing Address
First Line	:	110 FOX TRAIL DR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-9061
Country	:	US
Telephone Number	:	678-491-5195
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 E MARTINTOWN RD STE A
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3425
Country	:	US
Telephone Number	:	803-993-9959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	03/11/2025

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