Provider Demographics
NPI:1518228972
Name:VILLALOBOS, ANNA KATHARINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHARINE
Last Name:VILLALOBOS
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 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5204
Mailing Address - Country:US
Mailing Address - Phone:479-968-1198
Mailing Address - Fax:479-967-1178
Practice Address - Street 1:1915 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2725
Practice Address - Country:US
Practice Address - Phone:479-968-1198
Practice Address - Fax:479-967-1178
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193670721Medicaid