Healthcare Provider Details

I. General information

NPI: 1487350997
Provider Name (Legal Business Name): PAIGE DANIELLE GONZALEZ M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N CHURCH ST
PALESTINE TX
75801-2381
US

IV. Provider business mailing address

186 COUNTY ROAD 2304
GRAPELAND TX
75844-5887
US

V. Phone/Fax

Practice location:
  • Phone: 903-723-3602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number119825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: