Provider Demographics
NPI:1245787266
Name:CASTILLO, KELLY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:667 LIGHTHOUSE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2667
Mailing Address - Country:US
Mailing Address - Phone:831-318-0558
Mailing Address - Fax:831-603-6061
Practice Address - Street 1:667 LIGHTHOUSE AVE STE 305
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2667
Practice Address - Country:US
Practice Address - Phone:831-318-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist