Provider Demographics
NPI:1326524174
Name:VILLINES, CATHRYN JOY
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:JOY
Last Name:VILLINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 MARYLANE DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6702
Mailing Address - Country:US
Mailing Address - Phone:479-790-7979
Mailing Address - Fax:
Practice Address - Street 1:2403 MARYLANE DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6702
Practice Address - Country:US
Practice Address - Phone:479-250-4355
Practice Address - Fax:479-553-7954
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
AR200090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1326524174Medicaid