MEDICARE: AMY COSTELLO

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	146.013411	IL

General Provider Information

NPI Number	:	1548711492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY COSTELLO

Provider Business Mailing Address
First Line	:	2028 LINCOLN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 LINCOLN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3449
Country	:	US
Telephone Number	:	708-415-8858
Fax Number	:

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

Provider Enumeration Date	:	10/16/2016
Last Update Date	:	01/13/2024

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1063426807 — ANDREW JOHN PETULLA P.T.
Practice Location Address:

2048 LINCOLN AVE
SAN JOSE, CA
95125-3449

Practice Phone: 408-448-1677
Practice Fax: 408-448-7060

1780109611 — CALIFORNIA EMERGENCY PHYSICIANS
Practice Location Address:

2048 LINCOLN AVE
SAN JOSE, CA
95125-3449

Practice Phone: 408-448-1677
Practice Fax:

1992709398 — FRED H OLIN M.D.
Practice Location Address:

9512 MAJESTIC OAK CIR
SAN ANTONIO, TX
78255-3449

Practice Phone: 210-698-0607
Practice Fax:

1215957675 — COURTNEY NORRIS PRYOR LCSW
Practice Location Address:

2703 ALBIN DR
SAN ANTONIO, TX
78209-3449

Practice Phone: 210-464-4772
Practice Fax:

1417066655 — MEDICAL CENTER ORTHOPAEDICS PA
Practice Location Address:

9512 MAJESTIC OAK CIR
SAN ANTONIO, TX
78255-3449

Practice Phone: 210-698-0607
Practice Fax: 210-614-7745

Directions to “ AMY COSTELLO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.