Provider Demographics
NPI:1235307455
Name:CASTELLUCCIO, CORRIE (BA)
Entity Type:Individual
Prefix:MS
First Name:CORRIE
Middle Name:
Last Name:CASTELLUCCIO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 N 93RD AVE APT 3113
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3203
Mailing Address - Country:US
Mailing Address - Phone:480-235-1836
Mailing Address - Fax:
Practice Address - Street 1:17958 W BROWN ST
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-4151
Practice Address - Country:US
Practice Address - Phone:623-466-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39845272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant