Healthcare Provider Details

I. General information

NPI: 1801692025
Provider Name (Legal Business Name): DENISE KELLY VILLALOBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SPRING VALLEY RD
DALLAS TX
75244-3631
US

IV. Provider business mailing address

2314 SILVER OAKS ST
NEW CANEY TX
77357-3105
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-2999
  • Fax:
Mailing address:
  • Phone: 713-870-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number44380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: