Provider Demographics
NPI:1285893156
Name:GONZALEZ, ESMERALDA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ESMERALDA
Middle Name:
Last Name:GONZALEZ
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 1:10500 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6322
Mailing Address - Country:US
Mailing Address - Phone:956-624-4642
Mailing Address - Fax:
Practice Address - Street 1:903 N FLAG ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2912
Practice Address - Country:US
Practice Address - Phone:956-354-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167033301Medicaid