Provider Demographics
NPI:1174870901
Name:CASTILLO, KATHLEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
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 1:600 E MAIN ST APT 308
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1083
Mailing Address - Country:US
Mailing Address - Phone:859-803-2869
Mailing Address - Fax:
Practice Address - Street 1:600 E MAIN ST APT 308
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1083
Practice Address - Country:US
Practice Address - Phone:859-803-2869
Practice Address - Fax:502-426-2045
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3056235Z00000X
KY140024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY140024OtherKENTUCKY BOARD OF SPEECH-LANGUAGE PATHOLOGY
MD12089467OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION