Provider Demographics
NPI:1962924621
Name:CASTANEDA, JOHANNA (MS, SLP-INTERN)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MS, SLP-INTERN
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, SLP-INTERN
Mailing Address - Street 1:11821 EAST FWY STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-2060
Mailing Address - Country:US
Mailing Address - Phone:346-766-9888
Mailing Address - Fax:
Practice Address - Street 1:11821 EAST FWY STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2060
Practice Address - Country:US
Practice Address - Phone:346-766-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist