Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MALISSA ANN COSTANZO, OWNER
Active Sole ProprietorMALISSA ANN COSTANZO, OWNER is a Emotionally Disturbed Children Residential Treatment healthcare provider located in FOREST LAKE, Minnesota. NPI 1003394479 is currently active in the NPPES registry. Verify at CMS.
Emotionally Disturbed Children Residential Treatment · FOREST LAKE, MN
Registration Details
- NPI Number
- 1003394479
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jul 30, 2018 (8.0864654138745 yrs)
- Last Updated
- Aug 1, 2018
- Licenses
-
1094965-1-HCBS (MN)1094965-1-HCBS (MN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
844 8TH AVE SEFOREST LAKE, MN, 55025Browse MN providers · Browse ZIP 55025
- Phone
- 6512725608
- Primary Specialty
-
Emotionally Disturbed Children Residential Treatment
320900000X
- Additional Specialty
- Emotionally Disturbed Children Residential Treatment
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.