Provider Demographics
NPI:1275934341
Name:GONZALEZ, LISA ALEXIS (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ALEXIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ALEXIS
Other - Last Name:SAKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:13155 SW 134TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4488
Mailing Address - Country:US
Mailing Address - Phone:786-842-3624
Mailing Address - Fax:786-329-6693
Practice Address - Street 1:13155 SW 134TH ST STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4488
Practice Address - Country:US
Practice Address - Phone:786-842-3624
Practice Address - Fax:786-329-6693
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013205900Medicaid