Provider Demographics
NPI:1922519248
Name:VILLANUEVA, JESSENIA SABIRE (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:SABIRE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 W CHARLESTON BLVD STE 38D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1934
Mailing Address - Country:US
Mailing Address - Phone:702-877-0808
Mailing Address - Fax:702-878-1322
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 38D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1934
Practice Address - Country:US
Practice Address - Phone:702-877-0808
Practice Address - Fax:702-878-1322
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027069235Z00000X
NVSP-2384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist