Healthcare Provider Details

I. General information

NPI: 1306754643
Provider Name (Legal Business Name): JENNA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S ARMSTRONG AVE
FRESNO CA
93727-6724
US

IV. Provider business mailing address

2412 WHITMORE AVE
CLOVIS CA
93619-9252
US

V. Phone/Fax

Practice location:
  • Phone: 559-524-7500
  • Fax: 559-264-7610
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: