=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780906941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAYDEE GONZALEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2010
-----------------------------------------------------
Last Update Date | 08/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615A GALE ST
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-5955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-712-9988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 719 CHIHUAHUA ST SUITE 107
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78040-5247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-723-3737
-----------------------------------------------------
Fax | 956-723-3736
-----------------------------------------------------
=====================================================
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 | 16801
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------