Provider Demographics
NPI:1669641429
Name:GONZALES, MELISSA D (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:GONZALES
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N RAUL LONGORIA RD STE N
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3728
Mailing Address - Country:US
Mailing Address - Phone:956-618-2419
Mailing Address - Fax:956-618-2114
Practice Address - Street 1:1201 N RAUL LONGORIA RD STE N
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3728
Practice Address - Country:US
Practice Address - Phone:956-618-2419
Practice Address - Fax:956-618-2114
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist