Individual ProviderJohanna CostelloSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address197 Pine St, Apt 24, Portland, ME 04102-3533(516) 319-3889PECOS EnrollmentBased on the most recent information from CMS, provider Johanna Costello does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1700180361Provider TypeIndividualFull NameCostello, JohannaGenderFemaleSole ProprietorNoEnumeration Date12/22/2010Last Updated12/22/2010Contact InformationPractice LocationPractice Address197 Pine St, Apt 24, Portland, ME 04102-3533Phone(516) 319-3889FaxUnlisted FaxMailing LocationMailing Address197 Pine St, Apt 24, Portland, ME 04102-3533PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicenseST2024Maine