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NPI Code Detail

MEDICARE: MRS. PAMELA DIANE GONZALEZ M.S., CCC-SLP

MEDICARE: MRS. PAMELA DIANE GONZALEZ M.S., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist100998

General Provider Information

NPI Number : 1508536673
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAMELA DIANE GONZALEZ M.S., CCC-SLP
Provider Business Mailing Address
First Line : 2615 BALCHUCK LN
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5349
Country : US
Telephone Number : 361-774-6806
Fax Number :
Provider Business Practice Location Address
First Line : 801 LEOPARD ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78401-2421
Country : US
Telephone Number : 361-695-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2021
Last Update Date : 09/20/2021

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Directions to “ MRS. PAMELA DIANE GONZALEZ M.S., CCC-SLP” Practice Location

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