MEDICARE: YVONNE YVETTE GAMEZ MS 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
1	235Z00000X	Speech-Language Pathologist	100515	TX
2	235Z00000X	Speech-Language Pathologist	4185	NM

General Provider Information

NPI Number	:	1598162372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE YVETTE GAMEZ MS CCC-SLP

Provider Business Mailing Address
First Line	:	601 E 1ST ST APT 320
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3205
Country	:	US
Telephone Number	:	806-282-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E 1ST ST APT 320
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3205
Country	:	US
Telephone Number	:	806-282-8660
Fax Number	:

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

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	11/22/2014

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Directions to “ YVONNE YVETTE GAMEZ MS CCC-SLP” Practice Location

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