Provider Demographics
NPI:1013113588
Name:GOMEZ, ELIZABETH YVONNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YVONNE
Last Name:GOMEZ
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:PO BOX 962416
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-2416
Mailing Address - Country:US
Mailing Address - Phone:940-290-0389
Mailing Address - Fax:
Practice Address - Street 1:1214 DOLTON DR
Practice Address - Street 2:STE202MLT223
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207
Practice Address - Country:US
Practice Address - Phone:940-290-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist