Doctor Name: | MRS. KIM K COSTELLO |
NPI Number: | 1306926233 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SO780 |
Business Practice Address: | 4500 I-55 North Suite 291, Highland Village Jackson, MS - 39211 |
Business Phone Number: | 6013620859 |
Business Fax Number: | 6013620870 |
Mailing Address: | 1006 Canterbury Pl E, BRANDON |
State: | MS |
Postal Code: | 390428105 |
Phone Number: | 6018255678 |
Fax Number: | |
NPI Enumeration Date: | 10/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SO780 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |