Michele Gonyer-Russell

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

104393 Issued in TX

Practice address

2203 Babcock Rd
San Antonio, TX 78229-4412

Phone

(210) 614-3911

NPI assigned

Apr 28, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Three Marketeers, Inc

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • San Antonio, TX
  • NPI 1205098126
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1376860452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2203 BABCOCK RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294412",
            "telephone_number": "210-614-3911",
            "fax_number": "210-625-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2203 BABCOCK RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294412",
            "telephone_number": "210-614-3911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONYER-RUSSELL",
        "first_name": "MICHELE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-28",
        "last_updated": "2021-05-13",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "104393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alice Kim Gong, MD
• Richard John Gong, MD
• Edward Gongora
• Camilo Alberto Gonima, M.D.
• Jake Gonta, CTRS
• Andrew Michael Gonzaba, MD
• Anna Pantusa Gonzaba, M.D.
• Gillian Gabrielle Gonzaba, APRN, NNP
• Michelle Renae Gonzaba
• Vincent Gregory Gonzaba, MD

• Speech-Language Pathologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.