Provider Demographics
NPI:1548679756
Name:GONZALES, MARISOL URIBE (SLP)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:URIBE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PERKINS DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3248
Mailing Address - Country:US
Mailing Address - Phone:515-526-6682
Mailing Address - Fax:575-523-7254
Practice Address - Street 1:1721 ANTHONY DRIVE
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021
Practice Address - Country:US
Practice Address - Phone:575-882-3401
Practice Address - Fax:915-772-4633
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist