MEDICARE: MRS. JODIE ELAINE CASTILLO LETCHER 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
1	235Z00000X	Speech-Language Pathologist	106156	TX

General Provider Information

NPI Number	:	1467124438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODIE ELAINE CASTILLO LETCHER MS-CCC-SLP

Provider Business Mailing Address
First Line	:	6745 CLEAR SPRING DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3750
Country	:	US
Telephone Number	:	817-301-8702
Fax Number	:

Provider Business Practice Location Address
First Line	:	6745 CLEAR SPRING DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3750
Country	:	US
Telephone Number	:	817-301-8702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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