Healthcare Provider Details

I. General information

NPI: 1396548442
Provider Name (Legal Business Name): ASHLEY NICHOLE VILANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 120
SAN ANTONIO TX
78211-3773
US

IV. Provider business mailing address

24 EVERGREEN DR
BROWNSVILLE TX
78520-8513
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-1785
  • Fax:
Mailing address:
  • Phone: 956-442-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number42710
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: