Provider Demographics
NPI:1720245749
Name:VILLANUEVA HILES, CARMEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:VILLANUEVA HILES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SONTERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-5003
Mailing Address - Country:US
Mailing Address - Phone:956-534-1916
Mailing Address - Fax:844-831-4567
Practice Address - Street 1:312 SONTERRA BLVD
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-5003
Practice Address - Country:US
Practice Address - Phone:956-534-1916
Practice Address - Fax:844-831-4567
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318597701Medicaid
TX173794201Medicaid
TX110069507Medicaid