MEDICARE: MS. LAREEN K CHONZENA 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
1	235Z00000X	Speech-Language Pathologist	110929	TX

General Provider Information

NPI Number	:	1841573383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAREEN K CHONZENA M.S. CCC/SLP

Provider Business Mailing Address
First Line	:	1007 E PARK AVE
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4500
Country	:	US
Telephone Number	:	903-731-8033
Fax Number	:	877-766-4987

Provider Business Practice Location Address
First Line	:	1007 E PARK AVE
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4500
Country	:	US
Telephone Number	:	765-309-7764
Fax Number	:	877-766-4987

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	10/14/2021

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