Provider Demographics
NPI:1982871091
Name:CASTILLO, MADI E (MS, SLP/ CCC-A)
Entity Type:Individual
Prefix:
First Name:MADI
Middle Name:E
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MS, SLP/ CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23210 WILLOW CANYON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3526
Mailing Address - Country:US
Mailing Address - Phone:917-731-8140
Mailing Address - Fax:
Practice Address - Street 1:1011 S TEXAS 6 SUITE 311
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-7749
Practice Address - Country:US
Practice Address - Phone:917-731-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAUD000109231H00000X
TX111957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist