Provider Demographics
NPI:1417101890
Name:GONZALEZ, NELSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:MR
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:GONZALEZ-TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:PO BOX 320165
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-0165
Mailing Address - Country:US
Mailing Address - Phone:718-499-3030
Mailing Address - Fax:
Practice Address - Street 1:415A 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6106
Practice Address - Country:US
Practice Address - Phone:718-499-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0104691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist