Provider Demographics
NPI:1396180386
Name:GONZALEZ, ABIGAIL (CSWI)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7101
Mailing Address - Country:US
Mailing Address - Phone:801-417-0131
Mailing Address - Fax:
Practice Address - Street 1:7651 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7101
Practice Address - Country:US
Practice Address - Phone:801-417-0131
Practice Address - Fax:801-955-9411
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
UT9307645-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health