Provider Demographics
NPI:1780035246
Name:GONZALEZ, AUDREY MARIE
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:MARIE
Last Name:GONZALEZ
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 1:3201 AIRLINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3571
Mailing Address - Country:US
Mailing Address - Phone:361-991-6222
Mailing Address - Fax:361-334-6666
Practice Address - Street 1:3201 AIRLINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3570
Practice Address - Country:US
Practice Address - Phone:361-991-6222
Practice Address - Fax:361-334-6666
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80474237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist