Provider Demographics
NPI:1154645463
Name:CASTRO, GIDA C (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:GIDA
Middle Name:C
Last Name:CASTRO
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 1:498 BANTRY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8121
Mailing Address - Country:US
Mailing Address - Phone:614-886-9012
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD
Practice Address - Street 2:SUITE 200B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1000
Practice Address - Country:US
Practice Address - Phone:614-595-9037
Practice Address - Fax:614-448-4702
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 10241235Z00000X
MA7798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist