Provider Demographics
NPI:1346300241
Name:GONZALEZ, DIANA PATRICIA (MS CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:PATRICIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-7006
Mailing Address - Country:US
Mailing Address - Phone:203-710-6150
Mailing Address - Fax:860-561-5094
Practice Address - Street 1:1245 FARMINGTON AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2667
Practice Address - Country:US
Practice Address - Phone:860-521-1213
Practice Address - Fax:860-561-5094
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000444237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter