Healthcare Provider Details

I. General information

NPI: 1720245749
Provider Name (Legal Business Name): CARMEN VILLANUEVA HILES M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 SONTERRA BLVD
JARRELL TX
76537-5003
US

IV. Provider business mailing address

312 SONTERRA BLVD
JARRELL TX
76537-5003
US

V. Phone/Fax

Practice location:
  • Phone: 956-534-1916
  • Fax: 844-831-4567
Mailing address:
  • Phone: 956-534-1916
  • Fax: 844-831-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: