Provider Demographics
NPI:1639756059
Name:VILLAGRA, SARAH KELLY (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KELLY
Last Name:VILLAGRA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14734 LABRADOR ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2417
Mailing Address - Country:US
Mailing Address - Phone:818-671-7891
Mailing Address - Fax:
Practice Address - Street 1:16255 VENTURA BLVD STE 707
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2312
Practice Address - Country:US
Practice Address - Phone:818-941-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist