MEDICARE: HANNAH COSTELLO WILTSE LCSW

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	101YM0800X	Mental Health Counselor	117180	NY

General Provider Information

NPI Number	:	1508629775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH COSTELLO WILTSE LCSW

Provider Business Mailing Address
First Line	:	225 N MICHIGAN AVE STE 1430
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7653
Country	:	US
Telephone Number	:	312-766-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 WYATT DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-2352
Country	:	US
Telephone Number	:	585-455-9767
Fax Number	:

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	06/12/2026

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