Provider Demographics
NPI:1235714767
Name:GONZALEZ, LISBET (BS SLP-A)
Entity Type:Individual
Prefix:
First Name:LISBET
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BS SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 FONTAINEBLEAU BLVD APT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5525
Mailing Address - Country:US
Mailing Address - Phone:786-482-0158
Mailing Address - Fax:
Practice Address - Street 1:9435 FONTAINEBLEAU BLVD APT 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5525
Practice Address - Country:US
Practice Address - Phone:786-482-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI45352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant