Healthcare Provider Details

I. General information

NPI: 1104351154
Provider Name (Legal Business Name): SUSANA VILLARREAL MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANA RODRIGUEZ

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

2958 POWERS AVE
CLOVIS CA
93619-7404
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-2144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: