Provider Demographics
NPI:1891295044
Name:GOMEZ BRAUER, ILIANA ARELI (SLP-A)
Entity Type:Individual
Prefix:MISS
First Name:ILIANA
Middle Name:ARELI
Last Name:GOMEZ BRAUER
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 CALLE MONTOYA
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-7103
Mailing Address - Country:US
Mailing Address - Phone:520-470-9481
Mailing Address - Fax:
Practice Address - Street 1:3500 W ORANGE GROVE RD APT 11204
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2861
Practice Address - Country:US
Practice Address - Phone:520-470-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA110472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant