Provider Demographics
NPI:1558411041
Name:GONZALEZ, SANDRA MONICA (PSYD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MONICA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST STE 411
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2215
Mailing Address - Country:US
Mailing Address - Phone:503-228-0939
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST STE 411
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2215
Practice Address - Country:US
Practice Address - Phone:503-228-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist