Provider Demographics
NPI:1477035046
Name:VILLARREAL, JESSICA JANET
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JANET
Last Name:VILLARREAL
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 1:410 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3608
Mailing Address - Country:US
Mailing Address - Phone:956-735-9133
Mailing Address - Fax:956-263-1139
Practice Address - Street 1:410 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3608
Practice Address - Country:US
Practice Address - Phone:956-735-9133
Practice Address - Fax:956-263-1139
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant