Provider Demographics
NPI:1730988098
Name:VILLAGOMEZ, JAMIE (CF)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PATRICIA ANN PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4627
Mailing Address - Country:US
Mailing Address - Phone:337-281-9368
Mailing Address - Fax:
Practice Address - Street 1:122 OLIVEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8187
Practice Address - Country:US
Practice Address - Phone:337-545-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist