Provider Demographics
NPI:1568659043
Name:GONZALEZ, WILMA ENID (MS)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:ENID
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0706
Mailing Address - Country:US
Mailing Address - Phone:787-826-7632
Mailing Address - Fax:
Practice Address - Street 1:410 AVE. HOSTOS CENTRO PEDIATRICO
Practice Address - Street 2:SUITE 1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-832-6015
Practice Address - Fax:787-832-6015
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist