| Doctor Name: | MS. KELLY SYLVANIA VILLAVICENCIO |
| NPI Number: | 1356625230 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 019291 |
| Business Practice Address: | 849 Boulevard E Apt 4b Weehawken, NJ - 070867044 |
| Business Phone Number: | 5515565218 |
| Business Fax Number: | |
| Mailing Address: | 849 Boulevard E Apt 4b, WEEHAWKEN |
| State: | NJ |
| Postal Code: | 070867044 |
| Phone Number: | 5515565218 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2011 |
| NPI Last Update Date: | 10/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 019291 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |