Provider Demographics
NPI:1568654028
Name:GONZALEZ, DALIA I (MS,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:MRS
Other - First Name:DALIA
Other - Middle Name:I
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3141 CENTER POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8433
Mailing Address - Country:US
Mailing Address - Phone:956-380-3400
Mailing Address - Fax:956-380-3448
Practice Address - Street 1:3141 CENTER POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8433
Practice Address - Country:US
Practice Address - Phone:956-380-3400
Practice Address - Fax:956-380-3448
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3476525-02Medicaid