Provider Demographics
NPI:1265698765
Name:CASTILLO, IMELDA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:CASTILLO
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 1:3613 ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5550
Mailing Address - Country:US
Mailing Address - Phone:956-225-8772
Mailing Address - Fax:956-587-0245
Practice Address - Street 1:3613 ROBIN AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5550
Practice Address - Country:US
Practice Address - Phone:956-225-8772
Practice Address - Fax:956-587-0245
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist