Provider Demographics
NPI:1871249011
Name:GONZALEZ, HEATHER DENISE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENISE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DENISE
Other - Last Name:OLIVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:201 N SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-4606
Mailing Address - Country:US
Mailing Address - Phone:361-362-6021
Mailing Address - Fax:
Practice Address - Street 1:201 N SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-4606
Practice Address - Country:US
Practice Address - Phone:361-362-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist