MEDICARE: ILEANA GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	37999

General Provider Information

NPI Number	:	1508367079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANA GONZALEZ

Provider Business Mailing Address
First Line	:	6622 RYAN HILLS CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-3443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6622 RYAN HILLS CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-3443
Country	:	US
Telephone Number	:	713-732-8530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “ ILEANA GONZALEZ ” Practice Location

Language	Start Address	Practice Location

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