Provider Demographics
NPI:1568073526
Name:GONZALEZ, ADILEN DINA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ADILEN
Middle Name:DINA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 ENCINO XING
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2407
Mailing Address - Country:US
Mailing Address - Phone:940-597-5813
Mailing Address - Fax:
Practice Address - Street 1:2525 LADD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-5308
Practice Address - Country:US
Practice Address - Phone:210-771-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist