Provider Demographics
NPI:1184035230
Name:VILLARREAL, NICOLE (SLPA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W MILE 3 RD STE A-103
Mailing Address - Street 2:
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1633
Mailing Address - Country:US
Mailing Address - Phone:956-585-9889
Mailing Address - Fax:956-585-9896
Practice Address - Street 1:123 W MILE 3 RD STE A-103
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-1633
Practice Address - Country:US
Practice Address - Phone:956-585-9889
Practice Address - Fax:956-585-9896
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372922355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant