Provider Demographics
NPI:1346713922
Name:GONZALEZ, CYNTHIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 LOS ARBOLES AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3879
Mailing Address - Country:US
Mailing Address - Phone:956-465-7756
Mailing Address - Fax:
Practice Address - Street 1:1058 PALM BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6168
Practice Address - Country:US
Practice Address - Phone:956-465-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty