Provider Demographics
NPI:1700368388
Name:GONZALEZ-VALDEZ, JESUSITA (MACCC/SLP)
Entity Type:Individual
Prefix:
First Name:JESUSITA
Middle Name:
Last Name:GONZALEZ-VALDEZ
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4124
Mailing Address - Country:US
Mailing Address - Phone:956-460-1553
Mailing Address - Fax:
Practice Address - Street 1:900 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5037
Practice Address - Country:US
Practice Address - Phone:956-682-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty