Provider Demographics
NPI:1558550632
Name:CASTANEDA, MELISA ILIANA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:ILIANA
Last Name:CASTANEDA
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 1:3620 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3467
Mailing Address - Country:US
Mailing Address - Phone:956-624-5602
Mailing Address - Fax:956-783-7109
Practice Address - Street 1:6422 S CAGE BLVD STE B
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6957
Practice Address - Country:US
Practice Address - Phone:956-475-3681
Practice Address - Fax:956-502-5485
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist