Provider Demographics
NPI:1326390212
Name:VILLARREAL, MARIA G (SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W POTTS ST
Mailing Address - Street 2:
Mailing Address - City:FALFURRIAS
Mailing Address - State:TX
Mailing Address - Zip Code:78355-4820
Mailing Address - Country:US
Mailing Address - Phone:956-890-3737
Mailing Address - Fax:800-442-5594
Practice Address - Street 1:9501 W STATE HWY 107
Practice Address - Street 2:STE 3.
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-1152
Practice Address - Country:US
Practice Address - Phone:956-890-3737
Practice Address - Fax:800-442-5594
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11951OtherPROFESSIONAL LICENSE