MEDICARE: MRS. DAROLYN GONZALES MS CCC 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	102249	TX

General Provider Information

NPI Number	:	1881717239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAROLYN GONZALES MS CCC SLP

Provider Business Mailing Address
First Line	:	4300 RED CLOUD DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4241
Country	:	US
Telephone Number	:	512-382-9918
Fax Number	:	512-382-9918

Provider Business Practice Location Address
First Line	:	4300 RED CLOUD DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4241
Country	:	US
Telephone Number	:	512-382-9918
Fax Number	:	512-382-9918

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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