Provider Demographics
NPI:1184274888
Name:VILLACRES, PAULA ANDREA (CCC-SLP/TSSLD-BE)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:ANDREA
Last Name:VILLACRES
Suffix:
Gender:F
Credentials:CCC-SLP/TSSLD-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BETHLYNN CT
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8802 144TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3234
Practice Address - Country:US
Practice Address - Phone:718-526-4139
Practice Address - Fax:718-297-0290
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist