MEDICARE: MRS. BRENDA GONZALES SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	20297	CA

General Provider Information

NPI Number	:	1497115943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA GONZALES SLP

Provider Business Mailing Address
First Line	:	11205 KNOTT AVE
Second Line	:	SUITE E
City	:	CYPRESS
State	:	CA
Zip	:	90630-5489
Country	:	US
Telephone Number	:	714-893-7399
Fax Number	:	714-893-7389

Provider Business Practice Location Address
First Line	:	11205 KNOTT AVE
Second Line	:	SUITE E
City	:	CYPRESS
State	:	CA
Zip	:	90630-5489
Country	:	US
Telephone Number	:	714-893-7399
Fax Number	:	714-893-7389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/25/2016

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Directions to “ MRS. BRENDA GONZALES SLP” Practice Location

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