Provider Demographics
NPI:1801185756
Name:CASTILLO, EVELYN Y (SLPA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:Y
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CALLE DEL NORTE
Mailing Address - Street 2:STE. 106
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 CALLE DEL NORTE
Practice Address - Street 2:STE. 106
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5959
Practice Address - Country:US
Practice Address - Phone:956-725-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358082355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171436201Medicaid