Provider Demographics
NPI:1144953605
Name:GONZALES, JULIA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 SONOMA SPRINGS AVE APT 1506
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7124
Mailing Address - Country:US
Mailing Address - Phone:575-520-0694
Mailing Address - Fax:
Practice Address - Street 1:390 CALLE DE ALEGRA
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3280
Practice Address - Country:US
Practice Address - Phone:458-957-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF7768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist