Provider Demographics
NPI:1083191068
Name:GOMEZ LENGEMAN, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GOMEZ LENGEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 ALTA CANADA LN APT 620
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8239
Mailing Address - Country:US
Mailing Address - Phone:817-791-7336
Mailing Address - Fax:
Practice Address - Street 1:2234 ALTA CANADA LN APT 620
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8239
Practice Address - Country:US
Practice Address - Phone:817-791-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345582355S0801X
TX117894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant