Provider Demographics
NPI:1740381854
Name:VILLARREAL, SHANAN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANAN
Middle Name:MARIE
Last Name:VILLARREAL
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 1:2107 S ASH CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6501
Mailing Address - Country:US
Mailing Address - Phone:480-699-3996
Mailing Address - Fax:
Practice Address - Street 1:914 E MONTEREY ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8111
Practice Address - Country:US
Practice Address - Phone:480-577-7941
Practice Address - Fax:480-413-9761
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist