Provider Demographics
NPI:1497115943
Name:GONZALES, BRENDA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:GONZALES
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 1:11205 KNOTT AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5489
Mailing Address - Country:US
Mailing Address - Phone:714-893-7399
Mailing Address - Fax:714-893-7389
Practice Address - Street 1:11205 KNOTT AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5489
Practice Address - Country:US
Practice Address - Phone:714-893-7399
Practice Address - Fax:714-893-7389
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist