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NPI Code Detail

MEDICARE: MS. KATELYN MARIE COSTELLO M.A. CF

MEDICARE: MS. KATELYN MARIE COSTELLO M.A. CF
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1831447911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATELYN MARIE COSTELLO M.A. CF
Provider Business Mailing Address
First Line : 23 VALLEY RD
Second Line :
City : LEVITTOWN
State : NY
Zip : 11756-2906
Country : US
Telephone Number : 516-732-1755
Fax Number :
Provider Business Practice Location Address
First Line : 2781 OSBORN DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-8629
Country : US
Telephone Number : 928-505-5552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2012
Last Update Date : 08/21/2012

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