MEDICARE: KAITLIN GONZALES

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	103TS0200X	School Psychologist	71120	TX

General Provider Information

NPI Number	:	1689244485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN GONZALES

Provider Business Mailing Address
First Line	:	6335 JOHN CHAPMAN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-2285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6335 JOHN CHAPMAN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-7824
Country	:	US
Telephone Number	:	210-557-6288
Fax Number	:

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

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	07/13/2021

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Directions to “ KAITLIN GONZALES ” Practice Location

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