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NPI Code Detail

MEDICARE: GENNINE CASTANEDA MS CCC SLP

MEDICARE: GENNINE CASTANEDA MS CCC SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility1980 154WI
2235Z00000XSpeech-Language Pathologist1980-154WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306991898
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENNINE CASTANEDA MS CCC SLP
Provider Business Mailing Address
First Line : 6405 PIZARRO CIR
Second Line :
City : MADISON
State : WI
Zip : 53719-1893
Country : US
Telephone Number : 608-848-7332
Fax Number :
Provider Business Practice Location Address
First Line : 3401 MAPLE GROVE DR
Second Line :
City : MADISON
State : WI
Zip : 53719-5013
Country : US
Telephone Number : 608-845-1000
Fax Number : 608-845-1001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 11/05/2015

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Directions to “ GENNINE CASTANEDA MS CCC SLP” Practice Location

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