Provider Demographics
NPI:1932482460
Name:COSTELLO, CLAIRE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 IVANHOE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2427
Mailing Address - Country:US
Mailing Address - Phone:315-468-4568
Mailing Address - Fax:
Practice Address - Street 1:211 IVANHOE AVE
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2427
Practice Address - Country:US
Practice Address - Phone:315-468-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007627-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist