Provider Demographics
NPI:1265393441
Name:VILLOLOVOS, MODESTIE IRENE (RBT)
Entity type:Individual
Prefix:
First Name:MODESTIE
Middle Name:IRENE
Last Name:VILLOLOVOS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 101ST ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2005
Mailing Address - Country:US
Mailing Address - Phone:567-377-9962
Mailing Address - Fax:
Practice Address - Street 1:2708 101ST ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2005
Practice Address - Country:US
Practice Address - Phone:567-377-9962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician