Provider Demographics
NPI:1194199646
Name:GONZALEZ, KRISTIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4306
Mailing Address - Country:US
Mailing Address - Phone:612-706-5543
Mailing Address - Fax:612-706-5555
Practice Address - Street 1:1800 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4306
Practice Address - Country:US
Practice Address - Phone:612-706-5543
Practice Address - Fax:612-706-5555
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9381OtherSTATE LICENSE