Individual provider Active NPI

Jessica Lynn Gonzales, SLP

  • Speech-Language Pathologist
  • San Benito, TX
National Provider Identifier
1619370673
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
110800 Issued in TX
Practice address
175 E Robertson St
San Benito, TX 78586-3859
Phone
(956) 399-8900
Fax
(866) 571-2523
NPI assigned
Oct 6, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 110800 TX Primary

Addresses

Primary practice location

175 E Robertson St
San Benito, TX 78586-3859

Mailing address

175 E Robertson St
San Benito, TX 78586-3859
Phone (956) 399-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
110800TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Easter Seals Rio Grande Valley Speech-Language Pathologist Past Accepting new patients
Shawhan Ot2 LLC Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1619370673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E ROBERTSON ST",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785863859",
            "telephone_number": "956-399-8900",
            "fax_number": "866-571-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 E ROBERTSON ST",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785863859",
            "telephone_number": "956-399-8900",
            "fax_number": "866-571-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-06",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "110800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Benito, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; 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.