Provider Demographics
NPI:1649006982
Name:CASTALDI, KIMBERLY ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:CASTALDI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 E DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3607
Mailing Address - Country:US
Mailing Address - Phone:918-227-6800
Mailing Address - Fax:
Practice Address - Street 1:1231 E DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-3607
Practice Address - Country:US
Practice Address - Phone:918-227-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist