Provider Demographics
NPI:1114499548
Name:VILLARREAL, MYRIAM NOEMI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:NOEMI
Last Name:VILLARREAL
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 1:326 WAXBERRY TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1635
Mailing Address - Country:US
Mailing Address - Phone:210-237-8819
Mailing Address - Fax:
Practice Address - Street 1:326 WAXBERRY TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256
Practice Address - Country:US
Practice Address - Phone:210-237-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-25
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112371235Z00000X
HISP-1774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist