MEDICARE: MONICA LIZETTE CASTILLO ROBERTSON MA, 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	SA20702	FL

General Provider Information

NPI Number	:	1508628694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA LIZETTE CASTILLO ROBERTSON MA, CCC-SLP

Provider Business Mailing Address
First Line	:	2632 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1152
Country	:	US
Telephone Number	:	239-470-7663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1152
Country	:	US
Telephone Number	:	239-470-7663
Fax Number	:

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

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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Directions to “ MONICA LIZETTE CASTILLO ROBERTSON MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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