MEDICARE: KATHERINE ANNA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558226969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNA GONZALEZ

Provider Business Mailing Address
First Line	:	18777 MIDWAY RD APT B-501
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-2787
Country	:	US
Telephone Number	:	469-620-9644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 ROYAL LN STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-3765
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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