=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194819094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADALENA MENDOZA-GONZALES M.S., CCC/SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 02/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 W 4TH ST
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-6047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-969-6822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1136 S 7TH ST
-----------------------------------------------------
City | ALAMO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78516-6993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-588-6541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 24684
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------