Provider Demographics
NPI:1649237819
Name:DECASTRO, JENNIFER LOUISE (AUD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LOUISE
Other - Last Name:CROMPTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:14911 NATIONAL AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2632
Mailing Address - Country:US
Mailing Address - Phone:408-356-1999
Mailing Address - Fax:408-356-1988
Practice Address - Street 1:14911 NATIONAL AVE
Practice Address - Street 2:STE 2
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2632
Practice Address - Country:US
Practice Address - Phone:408-356-1999
Practice Address - Fax:408-356-1988
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2720231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist