Provider Demographics
NPI:1417522665
Name:COSTELLO, LEANNE (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 SUGAR PINE CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1120
Mailing Address - Country:US
Mailing Address - Phone:315-380-6052
Mailing Address - Fax:
Practice Address - Street 1:5544 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5406
Practice Address - Country:US
Practice Address - Phone:716-580-3976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist