Provider Demographics
NPI:1396981981
Name:GONZALEZ, MARCIA LYNN (SLP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5012
Mailing Address - Country:US
Mailing Address - Phone:956-631-9171
Mailing Address - Fax:956-631-7566
Practice Address - Street 1:1217 W HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5012
Practice Address - Country:US
Practice Address - Phone:956-631-9171
Practice Address - Fax:956-631-7566
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10074235Z00000X
TX100741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist