Individual
IVY ANNA COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1441 S SAINT FRANCIS DR, SANTA FE, NM 87505-4037
(505) 982-2177
(505) 982-0620
Mailing address
1441 S SAINT FRANCIS DR, SANTA FE, NM 87505-4037
(505) 982-2177
(505) 982-0620
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
T-0114651
NM
Other
Enumeration date
07/31/2008
Last updated
07/31/2008
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