Provider Demographics
NPI:1265709851
Name:VILLARSON, MARTINA JANET (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:JANET
Last Name:VILLARSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GLENROCK RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6624
Mailing Address - Country:US
Mailing Address - Phone:609-601-1559
Mailing Address - Fax:
Practice Address - Street 1:100 GLENROCK RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6624
Practice Address - Country:US
Practice Address - Phone:609-601-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00504600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist