Provider Demographics
NPI:1740387885
Name:VILLANUEVA, PRISCILLA (MS,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:VILLANUEVA
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 1:1152 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-5016
Mailing Address - Country:US
Mailing Address - Phone:361-664-6085
Mailing Address - Fax:361-668-3804
Practice Address - Street 1:1152 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5016
Practice Address - Country:US
Practice Address - Phone:361-664-6085
Practice Address - Fax:361-668-3804
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist