Provider Demographics
NPI:1659851855
Name:CASTANEDA, MICHELLE YVETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W FRONTAGE RD # SPAJ
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2300
Mailing Address - Country:US
Mailing Address - Phone:956-787-6777
Mailing Address - Fax:
Practice Address - Street 1:1011 W FRONTAGE RD # SPAJ
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2300
Practice Address - Country:US
Practice Address - Phone:956-787-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant