Provider Demographics
NPI:1467782458
Name:GONZALEZ, ELAINE BERNABE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:BERNABE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11624 GROSVENOR LN
Mailing Address - Street 2:APT 3A
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3450
Mailing Address - Country:US
Mailing Address - Phone:347-806-3582
Mailing Address - Fax:
Practice Address - Street 1:11624 GROSVENOR LN
Practice Address - Street 2:APT 3A
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3450
Practice Address - Country:US
Practice Address - Phone:347-806-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015897-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist