Provider Demographics
NPI:1740336759
Name:GONZALEZ, ROBERTO (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
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 1:201 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2429
Mailing Address - Country:US
Mailing Address - Phone:956-473-2858
Mailing Address - Fax:
Practice Address - Street 1:201 LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2429
Practice Address - Country:US
Practice Address - Phone:956-473-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110336Medicaid