Provider Demographics
NPI:1518238641
Name:CASTILLO RODRIGUEZ, AMANDA YVONNE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:YVONNE
Last Name:CASTILLO RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:YVONNE
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:871 OLD ALICE RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8268
Mailing Address - Country:US
Mailing Address - Phone:956-541-2102
Mailing Address - Fax:956-541-2502
Practice Address - Street 1:871 OLD ALICE RD
Practice Address - Street 2:SUITE 600
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8268
Practice Address - Country:US
Practice Address - Phone:956-541-2102
Practice Address - Fax:956-541-2502
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366222355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36622OtherSTATE LICENSE