Provider Demographics
NPI:1669106225
Name:VILLALPANDO, JACQUELINE (SLP-A)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:VILLALPANDO
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BOARDMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3722
Mailing Address - Country:US
Mailing Address - Phone:843-200-9600
Mailing Address - Fax:843-872-0511
Practice Address - Street 1:27 BOARDMAN RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3722
Practice Address - Country:US
Practice Address - Phone:843-200-9600
Practice Address - Fax:843-872-0511
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81282355S0801X
CACA6851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7866Medicaid