Provider Demographics
NPI:1346798865
Name:GONZALEZ, SAMANTHA (MS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,
Mailing Address - Street 1:120 REPUBLICAN ST APT 409
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4749
Mailing Address - Country:US
Mailing Address - Phone:707-718-6973
Mailing Address - Fax:
Practice Address - Street 1:120 REPUBLICAN ST APT 409
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4749
Practice Address - Country:US
Practice Address - Phone:707-718-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60575776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist