Provider Demographics
NPI:1366822108
Name:CASTO, LACIE DANIELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:DANIELLE
Last Name:CASTO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3727
Mailing Address - Country:US
Mailing Address - Phone:304-552-6676
Mailing Address - Fax:
Practice Address - Street 1:2 LOCUST CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-3727
Practice Address - Country:US
Practice Address - Phone:304-552-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3764235Z00000X
WVSLP-1549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist