Provider Demographics
NPI:1225207509
Name:GONZALES, VANESSA GAIL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:GAIL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 W KOENIG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1131
Mailing Address - Country:US
Mailing Address - Phone:512-467-7006
Mailing Address - Fax:512-467-7025
Practice Address - Street 1:2011 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1131
Practice Address - Country:US
Practice Address - Phone:512-467-7006
Practice Address - Fax:512-467-7025
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist