Provider Demographics
NPI:1972093748
Name:VILLAGRAN, CATHERINE (MA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:VILLAGRAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:VILLAGRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, SLP
Mailing Address - Street 1:595 E COLORADO BLVD # M100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2039
Mailing Address - Country:US
Mailing Address - Phone:626-793-0937
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD # M100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-793-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist