Provider Demographics
NPI:1437525508
Name:GONZALEZ, EDNA (MS,ASSIST SLP)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS,ASSIST SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-0505
Mailing Address - Country:US
Mailing Address - Phone:956-739-1048
Mailing Address - Fax:
Practice Address - Street 1:2606 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-0505
Practice Address - Country:US
Practice Address - Phone:956-739-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344402355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34440Medicaid