Healthcare Provider Details

I. General information

NPI: 1073478277
Provider Name (Legal Business Name): KALI HALE COSTELLO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CONTINUUM DR STE A
LIVERPOOL NY
13088-4387
US

IV. Provider business mailing address

3580 CODY RD
CAZENOVIA NY
13035-9714
US

V. Phone/Fax

Practice location:
  • Phone: 315-450-4898
  • Fax:
Mailing address:
  • Phone: 315-741-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: