Provider Demographics
NPI:1780966986
Name:STILLO SPEECH-LANGUAGE SERVICES P.C.
Entity type:Organization
Organization Name:STILLO SPEECH-LANGUAGE SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOELIA
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:786-382-4729
Mailing Address - Street 1:618 W 177TH ST
Mailing Address - Street 2:5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7110
Mailing Address - Country:US
Mailing Address - Phone:786-382-4729
Mailing Address - Fax:
Practice Address - Street 1:618 W 177TH ST
Practice Address - Street 2:5D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7110
Practice Address - Country:US
Practice Address - Phone:786-382-4729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019113314000000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility