Provider Demographics
NPI:1235489394
Name:GONZALEZ, KRYSTEN NICHOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:NICHOLE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15771 SW 141ST CT
Mailing Address - Street 2:FL
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6801
Mailing Address - Country:US
Mailing Address - Phone:786-553-9584
Mailing Address - Fax:
Practice Address - Street 1:15771 SW 141ST CT
Practice Address - Street 2:FL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6801
Practice Address - Country:US
Practice Address - Phone:786-553-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist