MEDICARE: ADILEN DINA GONZALEZ M.S., CF-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	117200	TX

General Provider Information

NPI Number	:	1568073526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADILEN DINA GONZALEZ M.S., CF-SLP

Provider Business Mailing Address
First Line	:	2312 ENCINO XING
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2407
Country	:	US
Telephone Number	:	940-597-5813
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 LADD ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5308
Country	:	US
Telephone Number	:	210-771-3166
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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Directions to “ ADILEN DINA GONZALEZ M.S., CF-SLP” Practice Location

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