Provider Demographics
NPI:1336483072
Name:VILLAMAR, MARIA R (SLP-A)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:R
Last Name:VILLAMAR
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 W CRIVELLO AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-9787
Mailing Address - Country:US
Mailing Address - Phone:602-919-4216
Mailing Address - Fax:
Practice Address - Street 1:17958 W BROWN ST
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-4151
Practice Address - Country:US
Practice Address - Phone:623-535-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA80962355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant