Provider Demographics
NPI:1942782719
Name:GONZALEZ, KENDRA RENEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:RENEE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2502
Mailing Address - Country:US
Mailing Address - Phone:830-896-2323
Mailing Address - Fax:
Practice Address - Street 1:746 ALPINE DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2502
Practice Address - Country:US
Practice Address - Phone:830-896-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110739OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION