Provider Demographics
NPI:1245588920
Name:GONZALEZ, TRICIA L (MA)
Entity Type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2413 GREENSPIRE WAY
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7482
Mailing Address - Country:US
Mailing Address - Phone:920-355-3300
Mailing Address - Fax:920-482-5789
Practice Address - Street 1:620 E LONGVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2149
Practice Address - Country:US
Practice Address - Phone:920-355-3300
Practice Address - Fax:920-482-5789
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1382-226101YP2500X
WI5457-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional