Provider Demographics
NPI:1588394365
Name:GONZALEZ, ANDREA MICAELA (AUD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICAELA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HERMANN MUSEUM CIRCLE DR APT 4012
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7385
Mailing Address - Country:US
Mailing Address - Phone:956-236-2819
Mailing Address - Fax:
Practice Address - Street 1:4191 BELLAIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1016
Practice Address - Country:US
Practice Address - Phone:713-795-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81335231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist