Provider Demographics
NPI:1720568405
Name:MEDRANO, GINA MICHELLE
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 W SAM HOUSTON PKWY S APT 1532
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1567
Mailing Address - Country:US
Mailing Address - Phone:713-969-7191
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 440N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4431
Practice Address - Country:US
Practice Address - Phone:713-969-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371832355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant