Provider Demographics
NPI:1205205440
Name:VILLA, KERRI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:VILLA
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 1:2165 JUDGE FRAN JAMIESON WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6173
Mailing Address - Country:US
Mailing Address - Phone:850-723-2826
Mailing Address - Fax:
Practice Address - Street 1:2165 JUDGE FRAN JAMIESON WAY APT 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6173
Practice Address - Country:US
Practice Address - Phone:850-723-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP9296235Z00000X
FLSA12978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist