Provider Demographics
NPI:1023139664
Name:DECOSTE, ANGELIQUE LYONS (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ANGELIQUE
Middle Name:LYONS
Last Name:DECOSTE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FORD ST
Mailing Address - Street 2:APT. E
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5730
Mailing Address - Country:US
Mailing Address - Phone:978-655-5553
Mailing Address - Fax:
Practice Address - Street 1:112 FORD ST
Practice Address - Street 2:APT. E
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5730
Practice Address - Country:US
Practice Address - Phone:978-655-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist