Provider Demographics
NPI:1770790040
Name:VILLA, KENDAL C (CCC - SLP)
Entity type:Individual
Prefix:MRS
First Name:KENDAL
Middle Name:C
Last Name:VILLA
Suffix:
Gender:F
Credentials:CCC - SLP
Other - Prefix:MISS
Other - First Name:KENDAL
Other - Middle Name:C
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP CFY
Mailing Address - Street 1:101 PIN OAK CT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-7292
Mailing Address - Country:US
Mailing Address - Phone:361-701-8865
Mailing Address - Fax:
Practice Address - Street 1:5606 N NAVARRO ST STE 200
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1758
Practice Address - Country:US
Practice Address - Phone:361-220-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102906OtherSPEECH LICENSE
TX164704201Medicaid
TX102906OtherSPEECH LICENSE