Malissa Ann Costanzo, OWNER
NPI #1003394479 in Forest Lake, Minnesota
Provider Information
- NPI Number
- 1003394479
- Entity Type
- Individual
- Name
- Malissa Ann Costanzo, OWNER
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Credential
- OWNER
- Enumeration Date
- Jul 30, 2018
- Last Updated
- Aug 1, 2018
Practice Location
- Address
- 844 8TH AVE SE
- City
- Forest Lake
- State
- Minnesota
- ZIP Code
- 55025
- Phone
- (651) 272-5608
Specialties & Taxonomy Codes
| Specialty |
|---|
| Foster Care Agency |
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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