Individual
DAVID WAYNE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
777 E BATTLEFIELD ST, SUITE 102B, SPRINGFIELD, MO 65807-4807
(417) 597-4572
Mailing address
1217 E 10TH ST, PLANKINTON, SD 57368-2056
(417) 894-4028
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2011041274
MO
104100000X
Social Worker
2915
SD
Other
Enumeration date
12/25/2011
Last updated
12/25/2011
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