Individual
MRS. KIM K COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
4500 I-55 NORTH, SUITE 291, HIGHLAND VILLAGE, JACKSON, MS 39211
(601) 362-0859
(601) 362-0870
Mailing address
1006 CANTERBURY PL E, BRANDON, MS 39042-8105
(601) 825-5678
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SO780
MS
Other
Enumeration date
10/16/2006
Last updated
07/08/2007
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