Provider Demographics
NPI:1104291590
Name:LUGO GONZALEZ, JANICE
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:LUGO GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 ROYAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-9619
Mailing Address - Country:US
Mailing Address - Phone:940-703-2907
Mailing Address - Fax:
Practice Address - Street 1:2905 ROYAL ACRES DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-7620
Practice Address - Country:US
Practice Address - Phone:940-703-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15632355S0801X
PR4024235Z00000X
TX114557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant