Provider Demographics
NPI:1558589705
Name:GONZALEZ OGANDO, YVETTE (SLP)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:GONZALEZ OGANDO
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 1:5709 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3282
Mailing Address - Country:US
Mailing Address - Phone:956-728-1769
Mailing Address - Fax:
Practice Address - Street 1:5709 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3282
Practice Address - Country:US
Practice Address - Phone:956-728-1769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180014601Medicaid