Provider Demographics
NPI:1003330879
Name:ASISTIO, MARIANNE CASTRO
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:CASTRO
Last Name:ASISTIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 TOLTEC CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-4053
Mailing Address - Country:US
Mailing Address - Phone:702-339-8039
Mailing Address - Fax:
Practice Address - Street 1:777 E ANN RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2903
Practice Address - Country:US
Practice Address - Phone:702-339-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00001176562355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant