Provider Demographics
NPI:1932673225
Name:CASTILLO, PRISCILLA (AU D)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SUMMER LEE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5453
Mailing Address - Country:US
Mailing Address - Phone:972-771-5443
Mailing Address - Fax:
Practice Address - Street 1:1320 SUMMER LEE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5453
Practice Address - Country:US
Practice Address - Phone:972-771-5443
Practice Address - Fax:972-771-5444
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80946231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist