Healthcare Provider Details

I. General information

NPI: 1649240359
Provider Name (Legal Business Name): NANCY VILLAR SLP ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HOSPITAL DR
ANGLETON TX
77515
US

IV. Provider business mailing address

120 HOSPITAL DR
ANGLETON TX
77515
US

V. Phone/Fax

Practice location:
  • Phone: 979-849-2447
  • Fax: 979-848-8337
Mailing address:
  • Phone: 979-849-2447
  • Fax: 979-848-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number31228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: