Provider Demographics
NPI:1164160164
Name:GONZALES, CORY JOPLIN (SLP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:JOPLIN
Last Name:GONZALES
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FM 1488 RD APT 1222
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3918
Mailing Address - Country:US
Mailing Address - Phone:210-834-4162
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4959
Practice Address - Country:US
Practice Address - Phone:936-293-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116735235Z00000X
NY030778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist