=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164931267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOSELINE PATRICIA GONZALEZ SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2017
-----------------------------------------------------
Last Update Date | 09/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1715 EXPRESSWAY 83 STE B
-----------------------------------------------------
City | PENITAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78576-8335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-580-9911
-----------------------------------------------------
Fax | 956-580-8257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | FM 886 S PALO BLANCO ST
-----------------------------------------------------
City | SULLIVAN CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-580-9911
-----------------------------------------------------
Fax | 956-580-8257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 112793
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------