Provider Demographics
NPI:1225658479
Name:CASTILLO, JODI LYNN (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 SAN JUAN DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-1838
Mailing Address - Country:US
Mailing Address - Phone:714-809-2180
Mailing Address - Fax:
Practice Address - Street 1:1523 SAN JUAN DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-1838
Practice Address - Country:US
Practice Address - Phone:714-809-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist