Individual
JOHANNA COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
197 PINE ST, APT 24, PORTLAND, ME 04102-3533
(516) 319-3889
Mailing address
197 PINE ST, APT 24, PORTLAND, ME 04102-3533
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
ST2024
ME
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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