Provider Demographics
NPI:1164931267
Name:GONZALEZ, YOSELINE PATRICIA (SLP)
Entity Type:Individual
Prefix:
First Name:YOSELINE
Middle Name:PATRICIA
Last Name:GONZALEZ
Suffix:
Gender:F
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:FM 886 S PALO BLANCO ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595
Mailing Address - Country:US
Mailing Address - Phone:956-580-9911
Mailing Address - Fax:956-580-8257
Practice Address - Street 1:1715 EXPRESSWAY 83 STE B
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8335
Practice Address - Country:US
Practice Address - Phone:956-580-9911
Practice Address - Fax:956-580-8257
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist