Provider Demographics
NPI:1558130401
Name:GONZALEZ, ALEXIS YVETTE (SLPA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:YVETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:YVETTE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLPA
Mailing Address - Street 1:1149 W 190TH ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1149 W 190TH ST STE 2300
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4350
Practice Address - Country:US
Practice Address - Phone:310-892-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60602355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant