Provider Demographics
NPI:1245035559
Name:COSTELLO, ASHLEY LEEANN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LEEANN
Last Name:COSTELLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:VICCO
Mailing Address - State:KY
Mailing Address - Zip Code:41773-0332
Mailing Address - Country:US
Mailing Address - Phone:606-216-9866
Mailing Address - Fax:
Practice Address - Street 1:91 OAK RIDGE CT
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8595
Practice Address - Country:US
Practice Address - Phone:606-910-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator