Provider Demographics
NPI:1992452510
Name:GONZALEZ, KERENA MARTHA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERENA
Middle Name:MARTHA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 JADE KNL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-5016
Mailing Address - Country:US
Mailing Address - Phone:956-533-6608
Mailing Address - Fax:
Practice Address - Street 1:6407 JADE KNL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-5016
Practice Address - Country:US
Practice Address - Phone:956-533-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist