Provider Demographics
NPI:1871732396
Name:VILLARREAL, LAURA MARY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 DOVER
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2325
Mailing Address - Country:US
Mailing Address - Phone:954-384-6994
Mailing Address - Fax:
Practice Address - Street 1:1608 TOWN CENTER CIR STE A
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3639
Practice Address - Country:US
Practice Address - Phone:954-385-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist