Individual
AMY COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2028 LINCOLN AVE, SAN JOSE, CA 95125-3449
(708) 415-8858
Mailing address
2028 LINCOLN AVE, SAN JOSE, CA 95125-3449
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.013411
IL
Other
Enumeration date
10/16/2016
Last updated
01/13/2024
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