Provider Demographics
NPI:1538334487
Name:GOMEZ, JOSIE ISABEL (MACCCSLP)
Entity type:Individual
Prefix:MISS
First Name:JOSIE
Middle Name:ISABEL
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 RITTIMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5534
Mailing Address - Country:US
Mailing Address - Phone:219-826-0449
Mailing Address - Fax:
Practice Address - Street 1:636 RITTIMAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5534
Practice Address - Country:US
Practice Address - Phone:219-826-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist