Provider Demographics
NPI:1053142281
Name:VILLANUEVA, GLADYS (SLPA)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 W MOLLY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-5808
Mailing Address - Country:US
Mailing Address - Phone:480-979-1613
Mailing Address - Fax:
Practice Address - Street 1:3127 W MOLLY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-5808
Practice Address - Country:US
Practice Address - Phone:480-979-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA152812355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant