Provider Demographics
NPI:1023392875
Name:COSTELLO, LAURA MICHELLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:8 DAVISON PLZ
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1545
Mailing Address - Country:US
Mailing Address - Phone:347-717-4117
Mailing Address - Fax:347-717-4117
Practice Address - Street 1:8 DAVISON PLZ
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1545
Practice Address - Country:US
Practice Address - Phone:347-717-4117
Practice Address - Fax:347-717-4117
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002370231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist