Provider Demographics
NPI:1245561299
Name:GONZALEZ, STEPHANIE M (MA, MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 SYKES CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3048
Mailing Address - Country:US
Mailing Address - Phone:321-693-4709
Mailing Address - Fax:
Practice Address - Street 1:3498 NW FEDERAL HWY
Practice Address - Street 2:SUITE G
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4441
Practice Address - Country:US
Practice Address - Phone:321-693-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist