Provider Demographics
NPI:1114158482
Name:GONZALEZ, MELANIE RAE (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RAE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 W. 3 MILE LINE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573
Mailing Address - Country:US
Mailing Address - Phone:956-424-7555
Mailing Address - Fax:956-424-7805
Practice Address - Street 1:2007 W. 3 MILE LINE
Practice Address - Street 2:SUITE 7
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573
Practice Address - Country:US
Practice Address - Phone:956-424-7555
Practice Address - Fax:956-424-7805
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist