Provider Demographics
NPI:1316789365
Name:GONZALEZ CHAVEZ, TRACY NAOMI
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:NAOMI
Last Name:GONZALEZ CHAVEZ
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 1:350 VISTA COURT DR APT 2110
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8361
Mailing Address - Country:US
Mailing Address - Phone:469-594-1488
Mailing Address - Fax:
Practice Address - Street 1:930 W CENTERVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5854
Practice Address - Country:US
Practice Address - Phone:972-303-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX438632355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant