Provider Demographics
NPI:1003679812
Name:VILLALON, KASANDRA ROSE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:ROSE
Last Name:VILLALON
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 1:1815 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4309
Mailing Address - Country:US
Mailing Address - Phone:941-348-7562
Mailing Address - Fax:
Practice Address - Street 1:1815 5TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4309
Practice Address - Country:US
Practice Address - Phone:941-348-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist