Provider Demographics
NPI:1831447911
Name:COSTELLO, KATELYN MARIE (MA CF)
Entity type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:MARIE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MA CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2906
Mailing Address - Country:US
Mailing Address - Phone:516-732-1755
Mailing Address - Fax:
Practice Address - Street 1:2781 OSBORN DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-8629
Practice Address - Country:US
Practice Address - Phone:928-505-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist