MEDICARE: NICOLE VILLARREAL SLPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	37292	TX

General Provider Information

NPI Number	:	1184035230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VILLARREAL SLPA

Provider Business Mailing Address
First Line	:	123 W MILE 3 RD STE A-103
Second Line	:
City	:	PALMHURST
State	:	TX
Zip	:	78573-1633
Country	:	US
Telephone Number	:	956-585-9889
Fax Number	:	956-585-9896

Provider Business Practice Location Address
First Line	:	123 W MILE 3 RD STE A-103
Second Line	:
City	:	PALMHURST
State	:	TX
Zip	:	78573-1633
Country	:	US
Telephone Number	:	956-585-9889
Fax Number	:	956-585-9896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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Directions to “ NICOLE VILLARREAL SLPA” Practice Location

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