MEDICARE: KATELYN 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	103K00000X	Behavior Analyst	5530	TX

General Provider Information

NPI Number	:	1881280576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN GONZALEZ

Provider Business Mailing Address
First Line	:	1601 S MOPAC EXPY STE C300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-7077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 S MOPAC EXPY STE D400
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1461
Country	:	US
Telephone Number	:	737-270-1010
Fax Number	:	512-532-6160

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

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	08/02/2023

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