Individual
TIFFANY COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
406 DUNDEE RD, EAST PEORIA, IL 61611-1614
(217) 414-4858
Mailing address
406 DUNDEE RD, EAST PEORIA, IL 61611-1614
(217) 414-4858
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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