BLAKE EDWARD COSTELLO

FORT WAYNE, IN
NPI1154253557
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy106S00000X Behavior Technician
Enumeration Date2026-06-01
Last Update Date2026-06-01
Business Address
BLAKE EDWARD COSTELLO
2270 LAKE AVE
FORT WAYNE, IN 46805-5359
Phone number: 260-444-5649
Mailing Address
BLAKE EDWARD COSTELLO
2270 LAKE AVE
FORT WAYNE, IN 46805-5359
Phone number:
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