Provider Demographics
NPI:1508051343
Name:GONZALEZ, ESMERALDA E (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ESMERALDA
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 LIMA LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6420
Mailing Address - Country:US
Mailing Address - Phone:956-723-1309
Mailing Address - Fax:956-568-4671
Practice Address - Street 1:702 GALVESTON ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-4638
Practice Address - Country:US
Practice Address - Phone:956-568-4571
Practice Address - Fax:956-568-4671
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
676667OtherMEDICARE
TX2821076-01Medicaid
TX1986135-01Medicaid