Individual
JIM L GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3100 SAN ISIDRO ST NW, COCHITI ES, ALBUQUERQUE, NM 87107-1038
(505) 345-1432
Mailing address
3100 SAN ISIDRO ST NW, COCHITI ES, ALBUQUERQUE, NM 87107-1038
(505) 345-1432
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2155
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
72229
—
NM
Enumeration date
02/05/2007
Last updated
07/09/2007
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