Active NPI
Nadia Ivelisse Costa-Lugo, M.S. CCC-SLP
- Speech-Language Pathologist
- Mansfield, TX
National Provider Identifier
1609136282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 106708
- Practice address
- 605 E Broad St
Mansfield, TX 76063-1794 - Phone
- (817) 299-6300
- NPI assigned
- May 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 106708 | TX | Primary |
Addresses
Primary practice location
605 E Broad St
Mansfield, TX 76063-1794
Mailing address
605 E Broad St
Mansfield, TX 76063-1794
Phone (817) 299-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106708 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774915200000",
"number": "1609136282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 E BROAD ST",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760631794",
"telephone_number": "817-299-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 E BROAD ST",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760631794",
"telephone_number": "817-299-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTA-LUGO",
"first_name": "NADIA",
"middle_name": "IVELISSE",
"name_prefix": "Ms.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-17",
"last_updated": "2026-03-31",
"certification_date": "2026-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "106708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.